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816 
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UC-NRLF 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


Dunglison's  American  Medical  Library. 
THE 

STOMACH 

IN  ITS  MORBID  STATES; 

BEING 
A  PRACTICAL  ENQUIRY  INTO 

THE  NATURE  AND  TREATMENT  OF  DISEASES  OF  THAT 

ORGAN ; 

AND  INTO  THE  INFLUENCE  THEY  EXERCISE 

I  UPON  THE 

ORIGIN,  PROGRESS,  AND  TERMINATION  OP  DISEASES  OP 

THE  LIVER,  HEART,  LUNGS,  AND  BRAIN. 


BY  LANGSTON  PARKER, 

MEMBER    OF   THE   ROYAL    COLLEGE    OF   SURGEONS,    AND 
FELLOW    OF   THE    ROYAL    MEDICAL    AND   CHIRURGICAL    SOCIETY    OF   LONDON,    ETC. 


PHILADELPHIA: 

PUBLISHED  BY  A.  WALDIE,  NO.  46  CARPENTER  STREET. 
1839. 


TO 


JOSEPH  HODGSON,  ESQ.,  F.  R.  S.,  &c.,  «fcc. 


MY  DEAR  SIR, 

SOME  years  ago,  you  advised  the  completion  of  a  work 
on  Human  and  Comparative  Physiology,  the  plan  of  which  I 
submitted  to  your  judgment.  Circumstances  have  occurred  to 
delay,  at  least,  the  completion  of  that  work.  In  place  of  it,  permit 
me  to  dedicate  to  you  the  present  Treatise :  and  believe  me,  my 
dear  sir,  with  esteem  for  your  friendship  and  great  respect  for 
your  high  professional  attainments,  to  remain  ever 

Your  obliged  and  faithful 

Friend  and  servant, 

LANGSTON  PARKER. 


PREFACE. 


THE  work  I  now  lay  before  the  public  is  materially  different 
from  all  those  which  have  preceded  it  on  the  same  subject :  it 
is  neither  devoted  chiefly  to  the  consideration  of  pathological 
changes,  like  that  of  Dr.  Abercrombie,  nor  is  it  limited  to  one 
class  of  primary  morbid  states.  The  subject  of  organic  disease,  in 
itself,  has  never  appeared  to  me  so  important  as  that  of  the  pri- 
mary conditions  which  precede  it,  which,  by  their  continuance 
through  a  series  of  years,  ultimately  induce  incurable  affections, 
either  in  the  organs  where  they  are  seated,  or,  by  sympathy,  in 
remote  parts.  In  a  practical  point  of  view,  the  latter  is  of  infi- 
nitely greater  importance  than  the  former. 

It  is  from  this  circumstance  that  I  have  devoted  the  following 
treatise  principally  to  the  consideration  of  the  primary  morbid 
conditions  of  the  stomach,  and  the  diseases  they  induce,  by  sym- 
pathy, in  remote  parts,  as  the  liver,  lungs,  heart,  and  brain.  The 
primary  morbid  conditions  of  the  stomach  may  be  referred  to  two 
classes :  1.  Congestive  or  inflammatory  states ;  and,  2.  Affections 
of  its  sensibility,  both  organic  and  animal.  There  is  a  third  form — 
a  disordered  state  of  the  secretions,  which  I  must  denominate 
primary,  though  it  is  not  really  so :  we  cannot,  however,  appre- 
ciate any  pathological  condition  which  precedes  it. 

After  having  noticed  these  conditions  of  the  stomach,  their 
symptoms,  and  mode  of  treatment,  I  have  passed  to  the  considera- 
tion of  their  influence  upon  the  origin,  progress,  and  termination 
of  diseases  in  other  organs.  The  question  of  morbid  sympathy  is 
one  of  extreme  importance ;  and,  as  far  as  the  present  subject  is 


VI  PREFACE. 

concerned,  I  am  not  aware  of  any  author,  with  the  exception  of 
Dr.  James  Johnson,  who  has  more  than  touched  upon  trn  sympa- 
thies of  the  stomach  with  internal  organs.  I  have  here  endea- 
voured, in  some  measure,  to  illustrate  this  influence ;  convinced 
that  the  primary  morbid  states,  to  which  i  have  alluded  in  the 
earlier  parts  of  this  work,  are  daily  the  sources  of  disease  in 
remote  internal  organs,  which  ultimately,  by  their  continuance, 
terminate  in  organic  change. 

142,  Snow-hill,  Birmingham^ 
Jan.  15,  1838. 


THE 


STOMACH  IN  ITS  MORBID  STATES  &c. 


CHAPTER  I. 

OF    MORBID    STATES    OP    THE    STOMACH    CHARACTERISED    BY    IN- 
CREASED VASCULAR1TY. 

THE  stomach  presents  two  primitive  morbid  states  :  the  first  con- 
sisting in  lesions  of  its  sensibility,  and  the  second  in  lesions  of  its 
circulation  ;  the  latter  comprises  that  great  variety  of  form  in  dis- 
eases of  the  stomach  which  is  termed  inflammatory,  and  which  may 
vary  from  a  mere  increased  fulness  of  blood,  not  tending  to  the 
destruction  of  the  parts  in  which  it  is  seated,  to  the  different  forms  of 
inflammation  whose  continuance  is  necessarily  followed  by  organic 
change.  It  is  not  necessary  here  to  enquire  whether  the  second  is 
not,  in  all  instances,  the  consequence  of  the  first.  It  is  with  the 
latter  we  shall  commence  the  study  of  this  class  of  diseases. 

The  most  simple  forms  of  diseases  of  the  stomach,  in  which 
derangements  of  the  vascular  system  are  the  prominent  features,  are 
characterised  by  morbid  fulness  of  blood  in  the  mucous  coat,  which, 
interfering  with  the  functions  of  the  stomach,  interrupts  digestion, 
and,  if  unchecked,  ultimately  lays  the  foundation  of  inflammatory 
disease.  This  morbid  fulness  of  blood  in  the  mucous  coat  results 
from  irritation,  generally  prolonged  and  frequently  repeated.  The 
irritations  which  produce  sanguineous  congestion  of  the  mucous 
coat,  are,  most  commonly,  dietetic  errors  ;  and  it  then  bears  the; 
name  of  inflammatory  indigestion.  It  may,  however,  come  on  a? 
the  consequence  of  any  disease,  or  during  its  progress  ;  and  in  these 
instances  it  is  highly  necessary  that  the  state  of  the  stomach  should 
be  ascertained  before  any  plan  of  treatment  be  determined  on,  lest 
we  convert  what  is  merely  a  state  of  congestion  of  blood  into  a  true 
inflammation.  The  form  of  disease  which  we  are  considering  is,  in 
general,  not  dangerous  ;  and  if  it  remain  in  the  state  of  congestion 
merely,  disorganisation  of  the  stomach  is  not  to  be  apprehended, 
although  a  repetition  of  stimulants  or  irritations  may  easily  convert 
the  congestion  into  inflammation.  Persons  thus  affected  are  on  the 
brink  of  a  serious  disease,  but  not  in  it.  Sanguineous  cong  estn 
may  vary  in  situation  or  occupy  a  more  or  less  extensive  portion  ol 
the  stomach ;  hence  the  variety  of  symptoms  which  attend  it,  both 


8  PARKER  ON  THE  STOMACH. 

in  their  decree  of  intensity  and  the  number  of  sympathies  by  which 
they  are  accompanied.  The  symptoms  themselves  may  vary  from 
mere  distension  after  food,  to  constant  vomiting  attended  with  thirst, 
dull  pain,  fever  and  headach. 

Sanguineous  congestion  of  the  mucous  coat  of  the  stomach,  is 
commonly  termed  gastric  irritation,  indigestion,  dyspepsia;  by  the 
French,  surexcitation  gastrique,  embarras  gastrique^  digestion 
laborieuse.  It  may  appear  as  a  temporary  or  evanescent  affection, 
or,  from  its  constant  occurrence  in  the  evanescent  form,  it  may 
become  permanent.  The  general  symptoms  which  attend  it,  will 
be  found  illustrated  by  the  detail  of  a  few  cases  selected  from  those 
which  are  daily  presenting  themselves  to  our  notice. 

A  gentleman  accustomed  to  live  well,  after  more  than  usual  in- 
dulgence, applied  to  me  labouring  under  the  following  train  of 
symptoms,  which  had  harassed  him,  with  some  variation  for  two 
months : — constant  uneasiness  in  the  epigastrium,  increased  by 
pressure  and  taking  food  ;  his  meals  were  always  succeeded  by  dis- 
tension of  the  stomach,  flatulence,  nausea,  and  occasional  vomiting. 
He  had  cough,  hurried  breathing  occasionally,  and  palpitation,  an 
accelerated  pulse,  partial  headach,  with  giddiness  and  indistinct 
vision  ;  the  bowels  were  confined,  and  the  urine  was  scanty  and 
high-coloured  ;  the  tongue  moist,  coated,  red  at  its  point  and  edges, 
with  an  elevated  and  intensely  vivid  state  of  the  papillas.  To  these 
symptoms  are  commonly  added,  in  different  cases,  and  in  different 
individuals,  where  the  susceptibility  of  their  organs  are  different, 
thirst,  general  feelings  of  lassitude,  pains  in  the  chest,  back, 
shoulders,  or  upper  part  of  the  abdomen  ;  general  pulsations,  more 
marked  in  the  epigastrium,  and  synchronous  with  those  of  the  heart ; 
heat  in  the  palms  of  the  hands  or  soles  of  the  feet ;  flushing  of  the 
face,  co-existing  with  certain  local  symptoms  which  point  to  the 
stomach  as  the  sole  origin  of  all  this  mischief,  which  symptoms  are 
pain,  nausea,  or  vomiting  after  food,  with  most  distressing  flatulence, 
and  feelings  of  distension  and  fulness  about  the  stomach,  amounting 
almost  to  suffocation. 

It  may  be  said,  and  is  said  by  Broussais  and  the  pupils  of  his 
school,  that  these  symptoms  of  general  and  local  vascular  excite- 
ment are  dependent  upon  an  inflamed  and  not  merely  a  congested, 
state  of  the  mucous  membrane  of  the  stomach  ;  but  with  all  the 
great  respect  I  entertain  for  one  who  has  almost  created  our  present 
state  of  knowledge  on  gastric  diseases,  there  are  many  proofs  which 
lead  us  to  suppose  that  these  symptoms  are  not  indicative  of  a  true 
inflammation,  but  of  a  mere  evanescent  congestion,  or  fulness  of 
blood  in  the  part,  for  we  see  them  subsiding  with  the  cause  that 
produced  them  when  they  are  slight,  and  occurring  and  subsiding 
again,  and  thus  continuing  for  years,  without  producing  emaciation 
or  any  serious  state  of  disease.  Again,  the  disease  gives  way,  in 
many  cases,  in  twenty-four  hours,  to  a  proper  plan  of  treatment ; 
and  a  patient  will  change  from  a  state  of  suffering,  indicated  by  the 
symptoms  above  detailed,  to  one  of  perfect  health,  by  the  simple 


INCREASED  VASCULARITY  OF  THE  STOMACH.  V 

application  of  ten  or  a  dozen  leeches  to  the  epigastrium,  and  the 
administration  of  an  aloetic  aperient,  or  a  solution  of  some  neutral 
salt,  as  the  sulphates  of  soda  and  magnesia  in  some  bitter  infusion. 

It  would  be  difficult  to  ascertain  the  true  pathologic  character  of 
this  affection  (which  never  of  itself  is  fatal)  unless  we  had  oppor- 
tunities of  examining  its  nature  in  patients  dying,  during  its  con- 
tinuance, from  other  diseases. 

A  man,  aged  forty,  who  had  been  troubled  with  headach  for 
some  years,  eat  freely  of  cucumber  and  some  other  indigestible  food, 
which  produced  vomiting,  uneasiness  in  the  stomach,  distension, 
flatulence,  and  all  the  common  symptoms  of  indigestion.  During 
their  continuance  he  was  seized  with  giddiness,  which  terminated 
in  profound  coma,  in  which  state  he  died,  thirty  hours  after  its 
commencement.  On  examining  the  body,  eight  hours  after  death, 
the  middle  lobe  of  the  left  central  hemisphere  contained  a  softened 
portion  of  brain,  about  the  size  of  a  walnut.  The  mucous  mem- 
brane of  the  stomach  was  vividly  injected  in  patches,  which  were 
more  numerous  towards  the  pyloric  portion  of  the  organ.  This  case 
is  interesting  in  a  double  point  of  view: — first,  as  it  exhibits  the 
state  of  the  mucous  coat  of  the  stomach  during  a  fit  of  indigestion, 
and  explains  the  pathology  of  one  of  its  forms  ;  arid,  secondly,  we 
appear  to  trace  some  relation  between  the  affection  of  the  stomach 
and  the  old  standing  disease  of  the  brain.  The  sudden  invasion  of 
the  attack  of  indigestion  seems  to  have  produced  death  byre-acting 
upon  the  brain,  in  which  an  old  source  of  irritation  existed. 

The  preceding  case  shows  the  pathology  of  this  form  of  indiges- 
tion, consisting  in  mere  fulness  of  blood,  increased  determination, 
owing  to  an  increased  or  undue  irritation  in  the  stomach  from  the 
presence  of  indigestible  food.  This  state  of  stomach  is  termed  by 
Andral,  hyperemia1  of  the  stomach,  in  which  the  blood  is  propelled 
into  the  digestive  organs  from  some  irritating  cause.  It  is  a  state 
of  disease  approaching  to  inflammation,  but  ought  to  be  carefully 
distinguished  from  it.2  Dr.  Beaumont  has  shown  that  the  mucous 
membrane  of  the  stomach  becomes  red  and  dry  from  undue  excite- 
ment ;  sometimes  irregular,  circumscribed,  red  patches,  varying  in 
size  and  extent  from  half  an  inch  to  an  inch,  are  found  on  the  in- 
ternal coat.  These  appear  to  be  the  effect  of  congestion  in  the 
minute  blood-vessels  of  the  stomach.3  The  pathology  of  this  form 
of  disease  consists,  then,  in  mere  morbid  fulness  of  blood  in  the 
mucous  coat;  other  alterations  must  be  present  to  constitute  the 
true  inflammatory  condition.  These  alterations  are  observed  in  the 
change  either  of  the  colour  or  consistency  of  the  mucous  membrane 

1  £TTS£,  excess  of,  aT|txa,  blood. 

*  Cours  de  Pathologic  Interne,  p.  4,  Paris,  1836. 

3  These  observations  were  made  upon  Dr.  Beaumont's  man-servant  who 
had  a  fistulous  communication  with  the  stomach,  through  which  the  process 
of  digestion  could  be  observed.  A  portion  of  the  side  and  stomach  had  been 
carried  away  by  a  musket-shot.  The  doctor  kept  this  man  for  the  purpose 
of  making  experiments  upon  his  digestion. 

9— ft  park  It 


10  PARKER  ON  THE  STOMACH. 

in  thickening  or  softening  of  the  mucous  coat  itself,  or  alterations 
in  the  condition  of  the  submncous  cellular  or  muscular  coats. 
Andral  believes  that  true  inflammation  of  the  mucous  membrane  of 
the  stomach  is  seldom  unaccompanied  by  thickening. 

The  degree  of  local  or  constitutional  disturbance  which  attends 
a  superabundance  of  blood  in  the  mucous  coat  of  the  stomach,  will 
depend  upon  the  degree  of  congestion  and  its  extent,  whether  it  be 
confined  to  small  patches  of  redness,  or  extend  to  a  general  vascular 
fulness  of  the  whole  mucous  membrane  ;  in  the  former  instance  the 
symptoms  would  be  slightly  local  ones ;  in  the  latter,  a  general  state 
of  constitutional  disturbance  would  be  present.  This  state  of 
stomach  is  commonly  observed  at  the  commencement  both  of  erup- 
tive and  continued  fevers  ;  it  accompanies  and  complicates  almost 
all  inflammatory  diseases. 

The  local  symptoms  accompanying  this  form  of  disease  in  the 
stomach  are  commonly  very  slight ;  they  sometimes  disappear  in  a 
short  time  and  are  quickly  renewed  from  any  fresh  source  of  irri- 
tation. This,  in  Andral's  opinion,  stamps  it  at  once  as  a  disease 
distinct  from  inflammation.  The  following  case  exhibits  its  most 
simple  and  common  form  : — 

A  gentleman,  accustomed  to  live  freely  and  indulge  in  the  use  of 
malt  liquors,  became  troubled,  after  indulgence,  with  nausea,  acidity, 
and  distension  after  food  in  the  stomach  and  bowels.  The  tongue 
was  moist  and  coated.  He  had  no  headach,  nor  any  other  sym- 
pathetic affection.  The  ordinary  stomach  medicines  I  employ 
(referred  to  in  the  chapter  on  treatment)  cured  the  patient  in  twenty- 
four  hours. 

The  ease  with  which  the  first  attacks  of  gastric  irritation  are 
commonly  removed  induces  persons  to  believe  that  the  disease  is  of 
little  consequence,  and  that  repeated  attacks  occasion  no  further  in- 
convenience or  evil  than  that  felt  during  their  continuance  ;  but  it 
must  be  remembered  that  these  repeated  attacks  of  irritation,  pro- 
ducing congestion,  directly  debilitate  the  blood  vessels  of  the  mucous 
coat,  and  that  an  actual  state  of  inflammation  may  succeed  to  these 
repeated  irritations. 

It  is  evident  that  the  hundred  and  forty-fifth  aphorism  of 
Broussais1  relates  to  a  state  of  disease  in  which  mere  redness  of  the 
mucous  membrane  is  present,  which  may  continue  for  weeks, 
months,  and  years,  with  all  the  symptoms  of  indigestion  present 
during  the  whole  of  this  time,  and  no  organic  change  be  the  result. 
Even  after  the  long  continuance  of  such  disease,  the  stomach  inay 
return  to  its  healthy  state  under  a  proper  plan  of  diet  and  medica- 
tion. There  is  no  distinct  line  of  separation  to  be  drawn  between 
the  mere  fulness  of  blood  or  vascular  irritation  of  the  mucous  coat, 
and  an  actual  state  of  inflammation  ;  indeed,  the  former  appears  to 
be  but  the  primary  condition  of  the  latter,  although  disease  may 

1  La  plupart  des  dyspepsies,  gastrodynies,  gastralgies,  pyrosis,  cardialgies, 
et  toutes  les  boulimies  sont  1'effet  d'une  gastro- entente  chronique. — Examen 
des  Doctrines  Medicates,  Aphorism  cxlv. 


INCREASED  VASCULARITY  OF  THE  STOMACH.         11 

remain  fixed  in  the  first  form.  The  mere  irritation  of  the  stomach 
consequent  upon  occasional  excess  is  considered  by  some  as  a  shade 
of  inflammation.  "  Mere  gastric  irritation  (embarras  gastrique)," 
says  Roche,1  "is  certainly  an  evanescent  form  of  inflammation.  Its 
symptoms  consist  in  a  feeling  of  weight  and  uneasiness  about  the 
region  of  the  stomach,  loss  of  appetite  without  thirst,  bitterness  in 
the  mouth,  eructations,  and  nausea :  attempts  to  vomit,  and  even 
actual  vomiting  may  be  present."  These  are  the  symptoms  of  a 
common  bilious  seizure,  which  are  attributed  by  the  pathologists  of 
the  school  of  Broussais  to  a  slight  form  of  inflammation  of  the 
mucous  coat  of  the  stomach.  The  term,  inflammation,  is  here 
employed  to  designate  a  certain  degree  of  irritation,  of  which  the 
chief  morbid  state  is  preternatural  fulness  of  blood. 

The  terminations  of  this  state  of  disease,  which  is  characterised 
by  mere  symptoms  of  indigestion,  may,  if  neglected  or  ill-treated^  be 
various.  It  may,  in  the  stomach,  end  in  a  true  inflammatory  state, 
or,  from  the  constant  irritation  being  kept  up.  it  may  induce  disease 
in  other  organs  which  are  most  susceptible,  from  predisposition,  of 
being  thrown  into  a  state  of  disease.  These  organs  are,  generally, 
the  liver,  the  brain,  the  heart,  and  the  mucous  surfaces  of  the 
bronchiae.  To  the  latter  parts,  irritation  soon  spreads,  and  the 
stomach-cough  is  soon  added  to  continued  gastric  irritation. 
Hypertrophy  of  the  liver  very  commonly  succeeds  to  continued  vas- 
cular gastric  irritation,  without  any  inflammatory  disease  existing  in 
the  stomach,  which  would  of  itself,  prove  fatal  except  so  far  as  its 
influences  the  condition  of  other  organs.  Broussais,  Cruveilhier, 
Andral,  Carswell,  and  other  pathologists,  attribute  hypertrophy  of 
the  liver  to  a  continued  state  of  gastric  irritation  of  the  inflammatory 
kind.  Even  where  it  cannot  be  easily  traced  that  affections  of  the 
liver  are  directly  consequent  upon  gastric  irritation,  we  find  them 
so  closely  allied,  so  constantly  existing  together,  that  no  doubt  can 
be  entertained  of  their  mutual  dependence  and  relation.  Affections 
of  the  heart  commonly  cause  congestions  of  the  mucous  coat  of  the 
stomach,  which  are  accompanied  by  all  the  symptoms  of  indigestion, 
which  is  in  these  instances  commonly  then  taken  for  a  primitive 
disease.  I  was  consulted,  a  few  days  since,  by  a  gentleman  whose 
case  will  be  found  in  another  part  of  this  work  for  what  he  consi- 
dered mere  prolonged  and  obstinate  indigestion.  On  examining 
carefully  into  his  state,  I  discovered  that  he  had  extensive  valvular 
disease  of  the  heart,  and  that  his  stomach  disease  resulted  from  an 
unusual  quantity  of  blood  retained  in  the  mucous  coat  of  the 
stomach  and  its  veins  from  a  mechanical  obstacle  to  its  free  return 
to  the  heart,  caused  by  disease  existing  in  that  viscus.  On  the  other 
hand,  vascular  irritations  in  the  cardiac  portion  of  the  stomach,  act 
forcibly  upon  the  heart  by  increasing  the  force  and  frequency  of  its 
pulsations,  or  destroying  the  regularity  of  its  actions.  The  brain  may 
become  affected  from  the  well  known  sympathies  existing  between 

1  Dictionnaire  de  Medecine  et  de  Chiiurg.  Pratiques,  art.  Gastrite. 


12  PARKER  ON  THE  STOMACH. 

it  and  the  stomach,  particularly  if  there  be  any  old-standing  disease 
in  that  organ.  The  stomach,  however,  appears,  in  these  forms  of 
disease,  to  affect  the  head  through  the  medium  of  the  heart  by 
quickening  its  pulsations,  increasing  their  force,  and  thus  sending 
the  blood  with  greater  force  and  frequency  than  is  consistent  with 
the  healthy  state,  to  the  central  organ  of  the  nervous  system. 

All  inflammatory  and  feverish  diseases  are  accompanied,  in  a 
greater  or  less  degree,  by  vascular  irritation  of  the  stomach  ;  from 
the  intimate  connection  this  organ  has  with  all  parts  of  the 
economy,  it  is  liable  to  be  thrown  into  morbid  states  by  any  impres- 
sions made  upon  the  constitution  at  large,  or  upon  any  of  its  parts ; 
hence  we  see  how  prone  it  is  to  become  affected  during  the  pro- 
gress of  other  diseases.  During  the  progress  of  all  diseases  of 
whatever  kind,  we  must  ascertain  the  state  of  the  stomach  with 
reference  to  the  remedies  indicated  in  the  cure  of  the  particular 
disease  in  question.  Thus,  in  diseases  of  the  heart,  where  the  use 
of  foxglove  is  indicated,  it  is  a  matter  of  paramount  importance  to 
administer  it  only  when  the  stomach  is  healthy.  If  that  state  of 
vascular  irritation  which  so  commonly  accompanies  diseases  of  the 
heart  be  present,  and  which  of  itself  is  sufficient  to  excite  or  de- 
range the  heart's  action,  the  administration  of  digitalis  would  add 
to  the  affection  of  the  heart  by  irritating  the  stomach.  The  stomach 
being  the  medium  through  which  all  remedies  act,  it  is  necessary  that 
this  organ  should  be  in  a  state  to  receive  and  dispose  of  them  properly 
when  they  are  given,  or  the  stomach  will  be  irritated  instead  of  the 
disease,  which  medicines  are  given  to  relieve,  benefited.  These 
remarks  particularly  apply  to  the  use  of  irritating  and  stimulating 
diaphoretic  and  diuretic  medicines.  The  state  of  vascular  irritation, 
(forming  the  first  step  towards  inflammatory  disease,)  to  which  I 
arn  alluding,  is  very  commonly  set  up  at  the  termination  of  acute 
diseases,  during  the  period  of  convalescence,  probably  owing  to 
dietetic  errors  at  this  period ;  it  comes  on  during  a  period  of 
weakness,  and,  the  patient  not  making  the  progress  that  the 
practitioner  expects,  tonics  are  liberally  given;  but  still  the 
invalid  recedes  towards  a  perfect  relapse,  instead  of  becoming 
convalescent.  If  we  enquire  into  the  patient's  state  at  this  pe- 
riod, we  find  him  labouring  under  all  the  symptoms  of  vascular 
irritation  of  the  stomach;  such  as  flatulence,  nausea,  heat  and 
weight  in  the  epigastrium,  with  capricious  or  defective  appetite, 
with  or  without  a  loaded  tongue,  for  this  is  commonly  a  very 
deceptive  symptom.  A  little  attention  to  the  state  of  the  stomach, 
speedily  restores  the  patient  and  the  cure  becomes  complete.  It 
is  these  affections  of  the  stomach  coming  on  during  convalescence, 
that  frequently  produce  what  is  termed  by  the  French  "false 
convalescence." 

The  eruptive  and  continued  fevers  are  ushered  in  commonly  by 
shivering  and  sickness,  and  the  tongue  is  intensely  red  at  its  point 
and  edges.  If  the  epigastrium  be  examined  it  is  highly  sensible  to 
pressure,  and  is  the  only  part  of  the  belly  where  any  tenderness  is 


MORBID  STATES  DEPENDENT  UPON  ANEMIA.         13 

experienced.  This  tenderness  of  the  epigastrium,  and  vomiting, 
are  dependent  upon  vascular  irritation  of  the  stomach,  approach- 
ing the  inflammatory  state,  and  indicated  by  symptoms  which  are 
more  intense  than  in  other  forms  of  the  disease,  from  the  irritation 
occupying  the  whole  extent  of  the  mucous  membrane  of  the  sto- 
mach: this  is  probably  occasioned  by  the  accumulation  of  blood  in 
the  great  veins  of  the  epigastrium  during  the  cold  stage.  It  is 
more  than  probable  that  this  state  of  stomach,  at  the  commencement 
of  fever,  frequently  lays  the  foundation  of  the  aggravated  gastric 
and  gastro-enteric  diseases  upon  which  fever  depends  or  with  which 
it  is  associated,  and  which  sometimes  of  themselves  occasion  death. 


CHAPTER  II. 

OF  MORBID  STATES  OF  THE  STOMACH  DEPENDENT  UPON  ANEMIA. 

GREAT  discharges  of  blood,  particularly  those  occurring  after  par- 
turition, or  from  abortions,  occasionally  produce  all  the  symptoms 
of  vascular  irritation  of  the  stomach ;  such  as  flatulence,  fulness, 
tenderness  in  the  epigastrium,  with  pain  and  weight  after  food.  We 
find  here  the  same  symptoms  accompanying  a  deficiency  of  blood 
as  those  which  denote  a  superabundance  of  it.  I  shall  detail  a  few 
cases  of  this  kind,  in  order  to  give  a  clearer  idea  of  the  disease. 

A  lady,  aged  thirty,  miscarried  in  the  third  month  of  her  preg- 
nancy, at  which  time  she  lost  much  blood.  At  the  present  time, 
two  months  after  the  abortion,  she  is  labouring  under  the  following 
train  of  symptoms : — Great  pain  in  the  epigastrium,  aggravated  by 
pressure,  and  accompanied  by  strong  pulsation  in  this  region. 
Fulness,  pain,  and  distension  after  meals,  with  nausea,  occasional 
vomiting,  palpitations,  and  inactive  bowels.  A  medical  practitioner, 
supposing  these  symptoms  were  dependent  upon  some  inflammatory 
affection,  had  ordered  leeches  to  the  stomach,  which  had  aggra- 
vated all  the  symptoms.  The  pil.  aloes,  assafoet.  et  saponis,  was 
ordered  subsequently,  to  regulate  the  bowels,  and  chalybeates  were 
freely  given.  Under  this  plan,  the  pain,  tenderness,  pulsations, 
vomiting  and  distension  disappeared,  and  the  patient  recovered  her 
usual  health. 

This  case  presents  all  the  symptoms  depending  upon  vascular 
irritation,  namely,  epigastric  tenderness  and  pulsations,  (which  latter 
are,  however,  but  rarely  present,  and  that  in  highly  irritable  pa- 
tients), vomiting,  with  distension  after  taking  food  ;  in  fact,  a  train 
of  symptoms  accompanying  laborious  digestion  generally,  and 
which  are  dependent  on  vascular  irritation  of  the  stomach.  Leeches 
here  afforded  no  benefit,  and  did  not,  in  the  slightest  degree,  remove 
the  symptoms.  The  patient,  however,  rapidly  recovered  under  a 
nutritious  diet  and  the  use  of  the  preparations  of  iron.  It  is  evi- 
dent, when,  we  review  the  previous  history  of  the  patient,  that  the 


14  PARKER  ON  THE  STOMACH. 

affection  was  produced  by  loss  of  tone  in  the  stomach,  the  conse- 
quence of  her  great  discharges,  which  had  produced  a  state  of  irri- 
tation similar  to  that  resulting  from  congestion  or  inflammatory 
action. 

A  lady,  aged  forty,  miscarried  in  the  early  months  of  her  preg- 
nancy; the  flooding  accompanying  the  abortion  was  most  profuse, 
and  she  remained  in  a  state  of  alarming  faintness  for  many  hours. 
On  the  second  day  after  she  began  to  complain  of  her  stomach. 
She  had  constant  nausea,  with  vomiting,  acidity,  and  flatulence, 
with  great  tenderness  in  the  epigastrium.  She  was  not  subject  to 
any  stomach  derangement  habitually.  Her  food  occasioned  great 
pain,  and  lay  like  a  "lump  of  lead,"  in  the  stomach.  The  symp- 
toms yielded  in  a  few  days,  under  the  administration  of  the  tinct. 
ferri  muriatis. 

A  lady,  aged  forty,  miscarried  a  fortnight  before  the  symptoms 
about  to  be  described  set  in ;  she  lost  a  vast  quantity  of  blood, 
which  produced  a  state  of  great  weakness  and  irritability.  She  now 
complains  of  great  oppression  and  fulness,  seated  in  the  epigastric 
region  ;  she  is  afraid  to  eat,  food  of  any  kind  increasing  the  oppres- 
sion to  such  an  extent  as  to  produce  a  feeling  of  impending  suffo- 
cation. Slight  pressure  over  the  stomach  occasions  a  sensation  of 
uneasiness,  which  the  patient  describes  as  dreadful.  Tongue 
moist,  but  coated ;  the  pulse  is  one  hundred  and  twenty,  sharp  and 
small;  lits  of  palpitation  occasionally;,  hurried  breathing,  with 
constant  cough.  Percussion  and  auscultation  afford  no  evidences 
of  disease  in  the  lungs  or  heart.  The  stools  are  scanty,  dark,  and 
offensive ;  the  urine  is  almost  suppressed,  and  constitutes  one  of 
the  most  troublesome  features  of  the  disease.  It  is  made  in  quan- 
tities of  not  more  than  four  or  five  table-spoonfuls  in  the  course  of 
twenty-four  hours,  and  this  is  altogether  composed  of  a  light  yellow 
sand.  This  state  of  urine  came  on  two  or  three  days  after  the 
distension  and  epigastric  uneasiness.  Small  doses  of  blue  pill  and 
aloes  were  given  at  bed-time,  and  in  the  day  the  patient  took  the 
tincture  of  the  muriate  of  iron  in  a  bitter  infusion.  The  diet  was 
to  consist  of  porter  and  animal  food.  Three  weeks  from  the  com- 
mencement of  this  plan  of  treatment  the  distension  and  uneasiness 
in  the  region  of  the  stomach  had  disappeared,  the  tongue  was  clean, 
the  bowels  regular,  and  the  urine  plentiful  and  clear.  In  a  week 
after  this  report  the  patient  was  perfectly  well ;  with  the  improved 
state  of  the  general  health,  and  the  increase  of  strength,  all  the 
symptoms  of  irritation  in  the  stomach  had  disappeared. 

A  lady  miscarried  early  in  her  pregnancy.  She  was  fainting 
and  almost  pulseless  for  two  or  three  days.  To  this  succeeded 
pain  in  the  stomach  after  food,  increased  by  pressure  and  accom- 
panied by  nausea,  eructations,  swelling  of  the  stomach,  and  vomit- 
ing. She  recovered  rapidly  under  the  use  of  the  tincture  of  the 
muriate  of  iron. 

A  lady  had  the  same  train  of  symptoms  after  profuse  menstrua- 
tion. She  recovered  from  using  the  same  medicines. 


MORBID  STATES  DEPENDENT  UPON  ANEMIA.  15 


OBSERVATIONS  UPON  THE  PRECEDING  CASES. 

The  stomach,  like  all  other  organs,  requires  a  due  supply  of 
blood  to  keep  it  in  a  healthy  state ;  and  if  it  be  deprived  of  this,  it, 
like  all  other  organs,  is  thrown  into  states  of  disease  which,  in  their 
characters,  strictly  resemble  those  which  result  from  excess  of 
blood,  yet  the  two  diseases  require  directly  opposite  modes  of  treat- 
ment. "It  is  a  law  in  pathology  that,  in  every  organ,  the  diminu- 
tion of  the  quantity  of  blood  which  it  should  contain  in  a  healthy 
state,  produces  functional  disturbances,  as  well  as  the  presence  of 
an  excessive  quantity  of  blood  ;  and  what  is  more,  in  both  cases 
these  functional  disturbances  are  precisely  similar."1  In  the  cases 
which  I  have  detailed,  we  observe  the  loss  of  blood  producing 
symptoms  of.  stomach  derangement  perfectly  analogous  to  those 
which  depend  upon  excess  of  blood,  or  upon  inflammation ;  if  we 
analyse  the  symptoms  they  are  the  same.  The  subject  of  the  third 
case  in  particular  exhibits,  in  the  most  marked  degree,  all  the  symp- 
toms attendant  upon  the  incipient  stages  of  inflammatory  disease 
of  the  stomach.  The  pain  after  food,  tenderness  in  the  epigastrium 
on  pressure,  vomiting,  scanty  urine,  are  what  commonly  denote  an 
inflammatory  state  of  the  mucous  membrane  of  the  stomach. 
"  We  have  often  seen,"  says  Andral,  "  individuals  who  seem  almost 
destitute  of  blood,  who  digested  with  pain  to  themselves,  and  some 
even  rejected  the  little  food  they  put  into  their  stomach.  After 
great  discharges  of  blood,  digestion  sometimes  remains  so  laborious 
that  the  stomach  is  unable  to  repair  its  losses.  The  stomach  here 
suffers  with  the  economy  at  large,  and  the  derangement  in  its  func- 
tions is  dependent  upon  constitutional  causes ;  but  the  peculiarity 
of  its  functions,  being  the  medium  through  which  strength  is  re- 
paired, and  its  ultimate  connection  with  all  parts  of  the  system, 
render  it  more  likely  to  be  disturbed  in  its  function,  by  causes  affect- 
ing the  economy  at  large,  than  any  other  organ.  Dr.  Graves  has 
recognised  this  form  of  stomach  disease  depending  upon  consti- 
tutional causes,  when  he  says  that  "it  is  sometimes  produced  by 
debility  of  the  vital  powers  of  the  stomach  and  intestines,  affected 
by  causes  which  act  on  the  whole  organisation."2 

1  Andral,  Clinique  Medicale,  Spillan's  translation,  p.  91 

2  Clinical  Lectures  in  the  London  Medical  and  Surgical  Journal,  vol.  vii. 
p.  642. 


16  PARKER  ON  THE  STOMACH. 


CHAPTER  III. 

GENERAL  REVIEW  OF  THE  SYMPTOMS  AND  SYMPATHIES  DEPEND- 
ENT ON  VASCULAR  IRRITATION  OF  THE  STOMACH. 

THE  inflammatory  nature  of  one  form  of  indigestion,  has  been 
admitted  by  many  writers,  but  the  affection  has  never,  to  my  know- 
ledge, been  clearly  followed  out  in  what  appear  to  be  its  most  im- 
portant points,  its  influence  upon  the  condition  of  other  organs. 
The  late  Dr.  Parry,  of  Bath,  considered  that  dyspepsia  itself  con- 
sisted in  a  morbid  fulness  of  the  vessels  of  the  mucous  coat  of  the 
stomach,  and  after  detailing  some  facts  in  proof  of  his  opinion,  he 
concludes  that  this  excessive  determination  would  probably  bring 
the  malady  within  the  limits  of  inflammation.1  The  opinions  of 
Broussais  on  this  point  are  the  same ;  he  attributes  the  greater  part 
of  all  forms  of  indigestion  to  chronic  inflammation  of  the  lining 
membrane  of  the  stomach.2  Bouillaud  observes  that  this  kind  of 
indigestion  differs  but  in  degree  from  that  form  of  irritation  known 
by  the  name  of  gastritis,  or  gastro-enteritis;  the  inflammatory  irri- 
tations of  the  stomach  assuming  a  series  of  shades  in  their  degrees 
of  intensity,  of  which  indigestion  of  this  kind  is  the  first  arid  most 
simple,  and  cholera  the  most  severe.3  Goupil4  Merot,5  and  others, 
all  admit  this  species  of  indigestion  as  a  symptom  or  group  of 
symptoms  of  a  diseased  condition  of  the  lining  membrane  of  the 
stomach,  which  is  characterised  by  inflammatory  action.  We  daily 
meet  in  society  a  class  of  persons  who  are  neither  well  nor  ill, 
complaining  of  want  of  appetite,  heaviness,  and  loss  of  spirits,  who 
are  distressed,  as  they  inform,  you,  with  constant  flatulence:  some- 
times there  is  a  disposition  to  take  food  of  a  savoury  character,  and  the 
appetite  may  be  capricious  or  variable ;  occasionally  a  fit  of  vomit- 
ing will  seize  them,  which  is  attributed  to  some  unwholesome  food 
which  has  been  eaten,  but  which  in  reality  is  owing  to  the  irritable 
and  diseased  condition  of  the  lining  membrane  of  the  stomach  ;  the 
tongue  is  foul,  the  mouth  dry,  and  the  bowels  almost  constantly 
confined,  to  which  latter  circumstance  all  the  evils  are  attributed, 
although  this  is  but  a  symptom  of  the  complaint — a  consequence, 
and  not  a  cause.  These  persons  are,  in  most  cases,  affected  with  a 
congested  or  inflamed  condition  of  the  mucous  membrane  of  the 
stomach.  Let  us  examine  the  symptoms  in  detail : — 

1  Elements  of  Pathology  and  Therapeutics,  by  C.  H.  Parry,  M.  D.,  Bath, 
3825.  p.  165. 

2Commentaires  de  Propositions  de  Pathologic,  t.  i.,  p.  277.     Paris,  1829. 
3Dictionnaire  de  Medecine  Pratique,  tome  x.,  art.  Indigestion. 

4  Exposition  des  Principes  de  la  Nouvelle  Doctrine  Medicale.    Paris,  1824. 

5  Dissertation  sur  la  Dyspepsie. 


VASCULAR  IRRITATION  OF  THE  STOMACH.  17 


OF  THE  STATE  OF  THE  TONGUE   IN  THE  PRIMARY  FORMS  OF 
VASCULAR   IRRITATION  OF  THE  STOMACH. 

In  inflammatory  irritation  of  the  stomach,  characterised  by 
symptoms  of  indigestion,  the  state  of  the  tongue  is  very  variable,  and 
hears  no  strict  relation  to  the  degree  of  disease  or  irritation  existing 
in  the  gastric  mucous  surfaces.  The  most  common  and  uniform 
state  is  a  contracted  tongue,  of  a  dry  appearance,  coated  in  the 
centre,'  and  vividly  red  at  its  point  and  edges  ;  the  papillae  are 
developed,  and  of  a  more  vivid  colour  than  the  red  surface  on 
which  they  are  placed.  This  condition  commonly  coincides  with 
the  ordinary  and  more  common  symptoms  of  distension  and  weight 
in  the  epigastrium,  nausea  and  vomiting.  Another  condition  occurs 
where  the  coating  of  the  tongue  spreads  over  its  whole  surface, 
through  which  the  papillae  appear  intensely  red  and  vivid;  the 
coating  extends  to  the  very  edge  of  the  tongue,  and  there  is  merely 
a  red  line  at  the  point  and  edges.  Generally  with  this  state  the 
sensibility  is  more  developed;  we  find  despondency,  languor,  and 
faintnes^.  with  indescribable  feelings  of  uneasiness  in  the  epigas- 
trium, which  are  brought  on  and  increased  by  pressure.  A  third 
state  occurs  where  the  tongue  is  red  and  smooth  ;  the  papillae  have 
almost  disappeared,  and  there  is  a  coating  in  two  distinct  lateral 
layers,  one  on  each  side  of  the  tongue.  "This,  in  most  instances, 
indicates  a  far  more  serious  degree  of  disease  than  the  other  two ; 
and  though  other  symptoms  may  not  be  so  strongly  marked,  still  this 
state,  though  merely  accompanied  by  the  ordinary  symptoms  of 
indigestion,  should  excite  our  suspicion  of  the  degree  of  complaint 
in  the  stomach  being  very  serious.  The  very  nature  of  these  dis- 
eases prevents  their  exhibiting  any  marked  physical  symptoms  ;  yet 
if  the  epigastric  region  in  these  conditions  of  tongue  be  carefully 
examined,  we  shall  commonly  find  it  hard  and  resisting,  indicating 
a  thickened  or  scirrhous  state  of  the  membranes  entering  into  the 
composition  of  the  stomach.  I  have  now  a  gentleman  under  my 
care  with  this  state  of  tongue,  who  is  forty-five  years  of  age.  He 
has  had  symptoms  of  indigestion,  with  vomiting  of  food,  for 
twenty-five  years,  doubtless  depending  upon  chronic  gastritis.  On 
examining  the  epigastrium,  there  is  a  distinct  and  almost  defined 
uneven  hardness,  which  is  probably  a  thickened  state  of  the  coats 
of  the  stomach  :  he  has  now  daily  vomiting  and  progressive  ema- 
ciation, which  hardly  offers  the  hope  of  recovery.  1  attended  an- 
other person,  for  two  years,  with  this  state  of  tongue,  who  gained 
but  temporary  relief  from  any  mode  of  treatment  adopted.  He 
died  at  the  end  of  this  time,  and  on  examination  the  coats  of  the 
stomach  were  found  much  thickened,  its  mucous  coat  uniformly 
and  intensely  injected,  with  the  liver  slightly  enlarged. 

Notwithstanding  what  I  have  said  of  the  occasional  coincidence 
of  a  certain  state  of  tongue  with  a  fixed  morbid  condition  of  the 
stomach,  still  the  state  of  the  tongue,  taken  as  an  isolated  symptom, 
9 — g  park  2 


18  PARKER  ON  THE  STOMACH. 

will  afford  no  certain  or  even  probable  data  on  which  to  act  in 
relation  to  the  pathologic  state  of  the  gastric  mucous  surface.  The 
results  of  my  own  observations  are  corroborated  by  those  of  Louis1 
and  Andral  ;2  and  although  the  researches  of  these  physicians  chiefly 
refer  to  the  relations  existing  between  the  state  of  the  tongue  and 
stomach  in  fever,  still,  as  Andral  justly  remarks,  the  same  discre- 
pancy exists  between  the  states  of  these  organs  in  other  diseases.  In 
the  earlier  stages  of  inflammatory  indigestion  there  is  every  variety 
of  tongue,  and  a  clean  and  moist  state  of  this  organ  may  be  found 
where  the  symptoms  of  gastric  irritation  are  very  urgent. 

A  lady,  eighteen  years  of  age,  was  brought  to  me,  suffering  from 
symptoms  of  inflammatory  irritation  of  the  stomach  ;  she  had  been 
irregular  in  her  menstruation  for  some  time.  There  was  tenderness 
and  heat  in  the  epigastrium,  with  corresponding  pains  in  the 
back  and  left  shoulder ;  she  had  constant  nausea,  with  daily  vomit- 
ing of  food,  and  a  full  hard  pulse,  at  one  hundred.  With  this  state 
the  tongue  was  pale,  broad,  and  moist.3 

Occasionally  a  state  of  inflammation  in  the  tongue  itself  coincides 
with  the  symptoms  of  which  we  have  been  speaking-.  Thus,  we 
occasionally  see  an  intensely  red  tongue,  with  aphthous  spots, 
which  is  a  purely  local  disease,  and  certainly  not  indicative  or  symp- 
tomatic of  any  gastric  disturbance  with  which  it  may  be  associated. 
I  have  a  gentleman  now  under  my  care  who  is  in  this  state.  The 
twenty-ninth  and  thirtieth  observations  of  Louis4  are  also  cases  of 
a  similar  character. 


OF  THE  STATE  OF  THE  EPIGASTRIC  AND  HYPOCHONDRIAC 
REGIONS. 

It  is  rare  not  to  find,  on  careful  examination  of  the  regions  cover- 
ing the  spleen,  stomach,  and  liver,  some  physical  signs  of  the  com- 
mencement of  inflammatory  irritation  of  the  stomach  or  the  organs 
strictly  dependent  on  it,  as  the  liver  and  spleen.  These  symptoms 
are  chiefly  fixed  pain,  fulness,  heat,  and  distinct  tumefaction. 
Fixed  pain  may  occur  in  several  situations;  on  the  left  of  the 
sternum,  deep  in  the  left  hypochondriurn,  in  the  epigastrium,  or  in 
the  right  hypochondriurn.  The  several  seats  of  pain  are  generally 
indicative  of  the  seat  of  complaint,  whether  it  be  in  the  cardiac 
portion  of  the  stomach,  in  the  greater  curvature,  or  in  the  pylorus. 
The  state  of  sensibility  in  the  centre  of  the  epigastrium,  which 

iDe  la  Gastro-Enterite,  &c.,  tome  ii.,  p.  64.     Paris,  1829. 

2Clinique  Medicale,  by  Spillan,  part  iv. 

3It  should  be  well  observed  that  in  the  same  manner  as  redness  of  the 
tongue  is  not  necessarily  connected  with  gastric  irritation,  so  whiteness  of 
the  tongue  does  not  always  exclude  the  existence  of  this  irritation.  It  is  for 
other  symptoms  to  disclose  this;  we  may  then  estimate  their  importance, 
and  calculate  how  far  the  existence  of  this  irritation  may  modify  the  treat- 
ment.— Andral,  p.  745,  part  iv. 

4  Op.  cit.,  tome  ii.,  pp.  66  and  77. 


VASCULAR  IRRITATION  OF  THE  STOMACH.  19 

corresponds  to  the  situation  of  the  great  nervous  ganglia  of  the 
abdomen,  is  extremly  deceptive,  since  most  persons  are  sensible  to 
moderate  pressure  in  this  situation.  Fulness  in  the  epigastrium 
and  left  hypochondrium  is  commonly  attendant  on  the  primary 
stages  of  disease ;  in  the  latter  periods,  when  the  coats  of  the  sto- 
mach become  thickened,  this  disappears,  and  is  replaced  by  a  resist- 
ing hardness  and  dull  percussion.  Fulness  and  distension  some- 
times run  to  so  distressing  an  extent  that  the  throat  feels  filled  with 
flatus,  and  the  stomach  and  bowels  are  distended  to  suffocation.  If 
much  gas  be  evolved  during  digestion,  the  sound  is  clear,  when 
these  regions  are  examined  by  percussion,  and  the  extent  of  this 
clearness  is  very  variable.  I  have  noticed  it,  as  in  the  subject  of 
Case  VI.,1  extending  below  the  umbilicus  ;  after  death  the  inflamed 
and  dilated  stomach  was  found  occupying  nearly  the  whole  of  the 
abdomen.*  Percussion  is  generally  clear  in  the  hypochondriac  and 
epigastric  regions  in  the  earlier  stages  of  inflammatory  disease  of 
the  stomach,  unless  this  organ  be  distended  by  aliment.  The  tem- 
perature is  always  elevated,  particularly  in  the  centre  of  the  epigas- 
trium. After  fits  of  repletion  in  persons  accustomed  to  live  well, 
and  who  habitually  carry  about  with  them  the  symptoms  of  chronic 
gastritis,  there  is  commonly  distinct  tumefaction  in  the  left  hypo- 
chondrium, which  appears  to  be  dependent  on  a  congested  state  of 
the  spleen.  I  have  often  found  the  spleen  much  enlarged  and 
united  by  strong  adhesions  to  the  stomach,  after  death  from  chronic 
gastritis :  the  subject  of  Case  I.2  affords  a  remarkable  example  of 
this  pathologic  state.3  Nausea  is  almost  an  invariable  attendant 
upon  inflammatory  indigestion;  it  may  occur  at  various  periods 
after  taking  food,  immediately,  or  at  any  time  during  the  first  two 
or  three  hours;  it  is  sometimes  the  first  indication  of  complaint, 
and,  coupled  with  vomiting,  often  continues  for  years  without  any 
other  marked  symptom  attracting  the  attention  of  the  patient.  These 
states  may  co-exist  with  pain,  or  the  latter  symptom  may  be  entirely 
absent ;  even  uneasiness,  or  tenderness  about  the  epigastrium,  or 
hypochondria,  may  be  entirely  wanting,  and  no  indications  of  dis- 
ease present,  except  nausea  and  vomiting.  I  have  often  seen  these 
symptoms  resist  every  attempt  at  cure,  except  leeches  to  the  epi- 
gastrium. 

Constipation  most  commonly  is  present,  but  there  are  states  of 
incipient  and  confirmed  inflammatory  disease  of  the  stomach  in 
which  the  bowels  are  either  regular  or  inclined  to  relaxation. 
Occasionally  there  are  alternate  states  of  constipation  and  diarrhoea. 
In  the  latter  stages  of  the  disease  the  latter  symptom  is  commonly 
present,  from  an  extension  of  disease  to  the  mucous  surfaces  of  the 
small  and  large  intestines. 

1  See  Case  VI.  in  the  chapter  on  the  influence  of  the  stomach  upon  the 
heart. 

2  See  Case  I.  in  the  chapter  on  the  influence  of  the  stomach  upon  the 
liver. 

8  See  Broussais,  Cours  de  Pathologie,  &c.,  tome  ii,,  p.  76. 


Jn 

20  PARKER  ON  THE  STOMACH. 

Pulsations  and  tremulous  motions  in  the  epigastrium  are  com- 
monly attendant  on  incipient  gastritis.  They  are  sometimes  eva- 
nescent, coming  on  for  a  few  minutes  or  an  hour,  and  then  ceasing  ; 
at  other  times  they  are  more  permanent,  constantly  present  during 
the  whole  continuance  of  the  disease.  They  are  sometimes  only 
evident  to  the  patient,  who  will  complain  of  beatings  in  this  situation 
which  no  manual  tact  can  discover,  but,  in  many  instances,  sensible 
not  only  to  the  hand  but  to  the  eye.  These  symptoms  are  gene- 
rally attended  by  others  which  indicate  a  state  of  exalted  sensibility. 
I  have  most  frequently  observed  them  where  the  disease  was  accom- 
panied by  great  anxiety  and  despondency;  in  these  instances  the 
epigastrium  has  always  been  hot  and  tender,  pressure  upon  it  not 
occasioning  so  much  pain  as  an  undescribable  feeling  of  wretched- 
ness and  uneasiness  in  the  patient,  which  is  commonly  by  htm 
termed  awful.  In  most  cases  they  have  been  cured  by  antiphlogistic 
treatment. 


OF  THE  STATE  OF  THE  ORGANS  OF  RESPIRATION. 

No  system  is  more  commonly  affected  from  inflammatory  disease 
in  the  stomach  than  the  organs  of  respiration.  The  strict  union 
of  the  stomach  with  the  diaphragm,  the  connection  of  this  with  the 
pleura,  and  the  latter  with  the  lungs,  and  the  strict  nervous  union 
by  the  branches  of  the  par  vagum,  render  the  sympathies  between 
the  organs  of  respiration  and  the  stomach  exceedingly  marked  and 
closet  Several  symptoms  of  disease  in  the  stomach  are  to  be  found 
in  the  organs  of  respiration.  The  first  is  a  short  dry  cough,  which 
has  been  denominated,  by  the  French,  toux  gastrique ;  sometimes 
this  is  the  only  symptom,  but  it  may  be  accompanied  by  expectora- 
tion of  frothy,  bloody,  heavy,  discoloured  mucus,  accompanied  by 
pains  in  the  sternum,  epigastrium,  hypochondria,  or  some  points  of 
the  thoracic  parietes. 

I  have  seen  acute  pains,  resembling  pleurisy,  supervene  upon 
this  gastric  disease,  and  evidently  produced  by  it ;  and  it  is  a  fact, 
of  which  I  daily  acquire  more  conviction,  that  many  persons 
ultimately  perish  from  chronic  bronchitis,  which  is  produced  by 
chronic  gastritis,  and  of  which  the  first  symptom  is  a  short  dry 
cough.  The  state  of  the  case  is  rendered  commonly  much  worse 
by  the  stimulating  expectorants  which  are  exhibited  to  relieve  the 
pectoral  disease.  Accelerated  respiration,  wilh  or  without  cough,  is 
another  symptom  in  the  organs  of  respiration  depending  upon  dis- 
ease of  the  stomach.  This  very  commonly  approaches  the  character 
of  pneumonia,  in  the  aspect  the  breathing  assumes,  when  no  disease 
of  the  lung  is  present ;  and  if  no  other  use  were  ever  to  be  made  of 
the  stethoscope,  its  value  in  ascertaining  the  state  of  the  lung  when 
the  respiration  is  hurried  or  quickened  from  causes  not  aifecting  the 
integrity  of  the  lung  or  its  membranes,  but  depending  upon  other 
causes,  would  entitle  it  to  be  ranked  among  our  most  important 
means  of  diagnosis.  In  children,  hurried  breathing  is  sometimes 


VASCULAR  IRRITATION  OF  THE  STOMACH.  21 

the  most  marked  symptom  of  gastritis  ;  occasional  sickness,  with 
cries  and  the  accelerated  respiration,  are  the  chief  marks  of  the  dis- 
ease. In  these  cases  we  are  almost  sure  to  wander  into  error,  unless 
guided  by  the  stethoscope,  the  more  marked  pulmonary  symptoms 
completely  masking  the  gastric  disease  which  produces  and  keeps 
them  up.  The  influence  of  disease  of  the  stomach  upon  the  organs 
of  respiration  has  attracted  the  attention  of  Stoll,1  Baillou,2  Brous- 
sais,3  and  Dr.  Philip  :4  by  some  other  physicians,  who  are  not  such 
good  pathologists  as  those  just  mentioned,  these  pulmonary  affec- 
tions have  been  treated  as  chimeras.  I  am  convinced,  from  long 
and  close  attention  to  this  class  of  diseases,  that  the  stomach  is  a 
most  common  source  of  pulmonary  disease. 


OF  THE  PULSE  AND  HEART. 


An  inflammatory  condition  of  the  mucous  membrane  of  the 
stomach  exerts  a  most  marked  influence  over  the  heart  and  arteries, 
independent  of  the  mere  increase  in  frequency  and  force  of  pulsa- 
tion which  is  characteristic  of  all  inflammatory  conditions,  whether 
acute  or  chronic.  The  state  of  the  susceptibility  of  the  nervous 
system  varies  much ;  and  hence  we  find  that  whilst  the  heart  is 
uninfluenced  in  the  regularity  of  its  actions,  in  many  instances,  in 
others,  fits  of  palpitation  are  present  which  threaten  suffocation. 
The  heart  may  be  affected  by  irritation  in  the  stomach  in  many 
ways  ;  by  mere,  increased  impulse,  by  occasional  intermissions  of 
its  pulsations,  or  by  irregular  and  tumultuous  motions.  In  some 
instances,  an  actual  physical  si^n  of  disease  may  be  present,  and 
after  death  the  heart  be  found  perfectly  healthy.  Cruveilhier  has 
recorded  a  case  of  this  nature,5  where  the  action  of  the  heart  and  the 
morbid  sound  it  emitted  were  dependent  upon  stomach  disease.  I 
have  recorded  another,  which  will  be  found  in  a  subsequent  part 
of  this  volume.  The  pulse  is  also  liable  to  occasional  variations, 
which  are  sometimes  independent  of  the  action  of  the  heart.  These 
symptoms  are  manifested  in  a  double  or  triple  motion  of  the  artery 
to  each  contraction  of  the  ventricle.  Many  cases  of  this  kind  will 
be  found  in  the  chapters  on  the  influence  of  the  stomach  upon  the 
heart.  Whilst  the  symptoms  which  mark  the  existence  of  disease 
in  the  stomach  are  found  principally,  in  some  instances,  marked  in 
the  heart,  so  are  the  symptoms  of  diseased  heart  sometimes  princi- 
pally manifest  in  the  derangement  of  the  functions  of  the  stomach. 
I  have  recorded  one  or  two  cases  where  the  only  symptoms  of  dis- 
eased heart  were  pain  and  tenderness  in  the  epigastrium,  nausea, 
distension,  and  weight  after  eating,  and  occasional  vomiting. 


1  Medecine  Pratique. 

2  Opera  Omnia. 

3  Histoire  des  Phlegmasies  Chroniques. 

4  Treatise  on  Indigestion. 

5  Anatomic  Pathologique. 


22  PARKER    ON    THE    STOMACH. 

Broussais1  is  of  opinion  that  the  complaint  in  the  stomach  is  gene- 
rally confined  to  its  cardiac  portion  when  the  sympathies  of  the 
heart  are  so  marked  ;  at  least  affections  of  this  part  act  more  easily 
upon  the  heart  than  when  disease  is  seated  in  other  portions  of  this 
viscus. 


OP  SYMPTOMS  PRESENTED  BY  THE   BRAIN  AND  SENSES. 

These  are  of  many  kinds,  and  are  manifested  in  the  brain  by 
stupor,  giddiness,  and  confusion  of  thought.  In  some  instances,  a 
great  degree  of  mental  excitement  is  present,  in  others  as  much 
despondency.  These  states,  however,  depend  very  much  upon  the 
natural  constitution  of  the  nervous  system,  and  its  degree  of 
susceptibility  to  impression.  In  a  great  number  of  instances  there 
is  li-ttle  affection  of  the  head,  and  this  is  then  confined  to  a  constant 
headach,  seated  in  the  temples  and  forehead.  Horrible  dreams  of  a 
peculiarly  vivid  and  distinct  character,  are  commonly  present.  The 
countenance  is  sometimes  puffed  or  bloated,  and  the  patient  has  a 
sense  of  not  being  able  to  collect  his  ideas  with  judgment  or  cer- 
tainty. The  states  of  excitement  in  the  brain  sometimes  approach 
complete  delirium,  and  occasionally  terminate  in  lunacy  or  mania. 
Bordeu,2  Pinel,3  Prost,4  Richond,5and  Broussais,6 dwell,  with  reason, 
upon  the  states  of  the  head  which  depend  upon,  or  are  produced  by, 
chronic  gastritis,  or  by  irritation  in  the  stomach.  In  reference  to  the 
senses,  the  symptoms  most  commonly  observed  are  either  a  diminu- 
tion in  the  acutehess  of  their  acustomed  degree  of  perception,  or 
an  exalted  and  depraved  exercise  of  this  power.  We  observe  in 
the  ear  dulness,  approaching  to  deafness,  or  an  acute  perception, 
which  magnifies  mere  whispers  into  loud  sounds.  In  the  functions 
of  the  eye  we  find  dimness  or  cloudiness  of  vision,  or  hallucinations, 
which  vary  from  the  simple  appearance  of  a  few  black  specks  float- 
ing in  the  air,  to  the  fancied  presence  of  one  or  more  objects,  whether 
of  animals  or  men.  These  cases  do  riot  commonly  occur,  and 
chiefly  are  owing  to  morbid  states  of  the  sensibility  of  the  organs 
in  which  they  are  met  with,  called  into  action  by  the  same  .state 
of  morbid  sensibility  in  the  gastric  nerves  ;  but  several  cases  will 
be  found  in  subsequent  pa^es,  where  these  depraved  sensations  were 
clearly  the  result  of  an  inflammatory  process. 

OF  LOCAL  PAINS. 

The  pains  which  are  symptomatic  of  inflammatory  diseases  of 
the  stomach  are  not  always  confined  to  the  epigastric  region  ;  pains 

1  Cours  de  Pathologie  et  Therapeutique  Generates. 

2  CEuvres  Completes,  par  Richerand. 

3  Nosographie  Philosophique. 

4  Medecine  Eclairee,  par  1'Observation  ef  1'Ouverture  des  Corps. 
6  De  I'lnfluence  de  1'Estomac  sur  la  Production  de  PApoplexie. 

6  Op.  cit. 


INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH.  23 

in  parts  of  the  thoracic  or  abdominal  parietes  may  co-exist  with 
pain  or  uneasiness  in  the  epigastrium,  or  this  may  be  entirely 
absent.  This  depends  altogether  upon  the  situation  in  which 
the  disease  in  the  stomach  exists,  whether  in  the  cardia,  in 
the  curvatures  or  in  the  pylorus.  Pain  in  the  centre  of  the 
sternum,  with  soreness  of  the  skin  in  this  situation,  and  absence  of 
uneasiness  in  the  epigastrium,  is  a  very  common  symptom.  We 
also  find  these  pains  on  either  side  of  the  sternum,  in  its  lower  half, 
in  the  mammae,  in  both  shoulders,  under  the  scapulae,  in  the  centre 
of  the  back,  and  in  the  throat,  with  difficulty  of  deglutition.  Shoot- 
ing pains  are  felt  also,  in  certain  cases,  on  almost  all  points  of  the 
lower  parts  of  the  chest.  These  pains  may  resemble  pleurisy  or 
pneumonia,  and  I  have  frequently  seen  persons  misled  by  them  ; 
here  the  stethoscope,  and  a  careful  analysis  of  the  conditions  of  the 
various  organs  of  the  chest  and  abdomen,  alone  can  guide  us.1  We 
have  these  pains  existing  without  accelerated  or  hurried  breathing 
or  cough,  and  when  this  is  the  case  we  may  generally  conclude  that 
they  are  not  connected  with  any  pulmonary  complaint.  They  may, 
however,  co-exist  with  these  symptoms  and  still  be  gastric.  Here 
the  stethoscope  is  our  only  safeguard. 


CHAPTER  IV. 

ON  CONFIRMED  INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH. 

The  passage  of  disease  from  the  mere  hyperemic  state  to  the  in- 
flammatory is  very  easy,  and  the  shades  which  separate  them  are 
very  faint ;  in  fact,  the  symptoms  which  accompany  the  first  state  are 
sometimes  more  marked  than  those  which  are  proper  to  the  second. 
In  the  hyperemic  state  we  have  sometimes  symptoms  of  great  inten- 
sity accompanying  digestion,  whilst  in  the  confirmed  inflammatory 
condition  there  is  occasionally  little  more  symptom  of  complaint 
than  obstinate  constipation,  with  dull  pain  in  the  epigastrium, 
hardly  perceived  till  the  patient's  attention  is  directed  to  it.  These 
symptoms,  co-existing  with  an  anxious  cast  of  countenance,  slight 
emaciation,  low  spirits,  and  slight  flatulence  after  food,  are  then  all 
that  denote  complaint. 


1  II  faut  eviter  de  rapporter  au  poumon  les  douleurs  lancinantes,  et  pongi- 
tives  qui,  partant  des  papilles  nerveuses  de  1'estomac  retreci,  et  remonte  sous 
la  voute  du  diaphragm,  pourraient  aller  retentir  aux  environs  du  mamelon. — 
F.  J.  V.  Broussais,  Histoire  des  Phlegmasies  Chroniques,  tome  iii.,  p.  45. 
Paris,  1829. 


24  PARKER  ON  THE  STOMACH. 


OF  INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH   ACCOMPANIED 
BY  A  PECULIAR  CONDITION  OF  THE  TONGUE. 

Man y  of  our  best  pathologists,  among  whom  are  Louis  and  Andral, 
are  of  opinion  that  there  is  no  direct  relation  existing  between  the 
state  of  the  tongue  and  the  state  of  the  stomach  in  disease  ;  that  is, 
that  the  former  does  not  afford,  as  it  has  been  supposed  to  do,  any 
certain  evidence  of  the  condition  of  the  latter.  Sometimes  the 
tongue  is  clean,  and  the  symptoms  of  disease  in  the  stomach  of  an 
aggravated  character,  and  strongly  marked  ;  at  other  times  we  find 
the  tongue  coated,  or  covered  with  aphthous  crusts,  and  intensely 
red  and  smooth  in  the  intervals  of  these  crusts.  This  may  exist 
without  any  affection  of  the  stomach.  We  again  find  that  this  state 
of  the  tongue  sometimes  exists  with  pure  chronic  gastritis,  but  that 
the  state  of  the  tongue  is  not  altogether  indicative  of  the  disease  in 
the  stomach,  but  results  in  a  great  measure,  from  local  disease  in 
the  tongue  itself.  Thus,  we  may  have  a  clean  tongue  with  a  dis- 
eased stomach,  a  diseased  tongue  with  a  healthy  stomach,  or  disease 
co-existing  in  both  organs,  but  independent  of  each  other. 

CASE   1. — Aphlhous  and  ulcerated   tongue  co-existing   with  symptoms   of 

chronic  gastritis. 

A  gentleman,  of  middle  a^e,  had  been  out  of  health  for  some  time, 
yet  no  very  marked  symptom  of  complaint  was  present  to  which 
his  attention  was  directed  ;  he  complained  merely  of  loss  of  spirits, 
had  bad  nights,  and  occasionally  a  little  nausea,  although  the  appe- 
tite was  good.  After  the  continuance  of  these  symptoms  for  some 
months,  during  which  time  the  countenance  acquired  a  sallow  tinge, 
the  tongue  became  dry,  red,  and  foul,  and  covered  with  aphthous 
crusts  ;  on  the  borders  of  the  tongue  the  white  incrustations  dropped 
off,  and  left  small  ulcerations  underneath.  In  the  intervals  the 
tongue  was  vividly  red  and  dry,  and  the  surface  thickly  loaded 
with  a  brown  fur.  With  this  state  of  tongue  there  existed  the  most 
obstinate  constipation  ;  the  bowels  were  never  relieved  without 
medicine,  and  when  suffered  to  pass  for  three  or  four  days,  without 
discharging  their  contents,  sickness  and  vomiting  succeeded.  The 
patient  suffered  from  great  languor  and  mental  depression  ;  the  pulse 
was  feeble,  creeping  and  slow.  On  examining  the  epigastrium  we 
found  there  existed  considerable  uneasiness  upon  slight,  pressure, 
occasionally  a  shooting  pain  was  felt,  and  the  patient  was  tormented 
with  flatulence.  The  emaciation,  although  the  disease  had  con- 
tinued for  many  months,  was  hardly  perceptible;  but  the  limbs  had 
lost  their  usual  firmness,  and  were  become  soft.  The  aphthons 
state  of  the  mouth  was  always  increased  by  constipation  ;  if  the 
bowels  were  kept  free  the  state  of  the  tongue  was  always  amended, 
but  if  constipation  was  suffered  to  continue  nausea  came  on,  and 


INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH. 

the  tongue  became  encrusted  and  dry,  the  gums  spongy,  and 
covered  with  spots  as  well  as  the  tongue. 

It  is  not  often  that  we  observe  this  aphthous  state  of  the  tongue 
and  gums  coinciding  with  chronic  gastritis  ;  for,  in  the  case  under 
consideration,  it  is  evident  that  the  state  of  the  tongue  arid  gums 
was  dependent  upon  that  of  the  stomach  ;  on  the  removal  of  the 
constipation,  and  keeping  the  patient  for  a  week  or  two  upon  fari- 
naceous food,  the  aphthse  would  disappear,  the  tongue  become 
moist,  and  lose  its  vividly  red  and  smooth  appearance,  whilst  a 
recourse  again  to  stimulating  food,  and  neglecting  the  state  of  the 
bowels,  would  as  constantly  bring  the  tongue  to  its  primitive  morbid 
condition,  and  the  symptoms  of  disease  in  the  stomach  would  return 
at  the  same  time.  It  must  not  be  forgotten  that  this  state  of  tongue 
and  gums  may  be  purely  local,  and  unconnected  with  any  stomach 
disease ;  depending  upon  an  inflammatory  state  of  these  organs 
themselves,  independent  of  disease  in  any  other.  Again,  we  see  it 
produced  by  gastritis,  as  in  the  present  instance,  and,  under  these 
forms,  is  generally  accompanied  by  a  depressed  state  of  the  vital 
powers  generally.  It  is  commonly  a  very  serious  symptom,  but  I 
have  seen  many  cases,  where,  under  a  judicious  treatment,  the 
aphthous  crusts,  have  fallen  off,  the  tongue  has  become  moist,  and 
the  gums  have  lost  their  spongy  appearance.  If  the  aphthous  state 
be  treated,  under  these  circumstances,  as  a  purely  local  disease,  and 
the  complication  of  gastritis  with  it  be  overlooked,  it  is  extremely 
probable  the  patient  will  die,  since  under  some  circumstances, 
chronic  inflammation  of  the  stomach  is  a  disease  of  so  insidious  and 
obscure  a  character,  even  when  it  has  occasionally  proceeded  to  a 
state  of  disorganisation  of  the  mucous  membrane,  that  a  superficial 
observer  may  pass  it  over.  Louis  has  recorded  two  cases,  in  his 
work,  De  la  Gastro- Enter  ite,  fyc.,  exhibiting  inflamed  and  ulce- 
rated states  of  the  tongue,  in  fever  independent  of  any  gastric 
affection.  These  states  may  doubtless  occur,  but  I  am  anxious  to 
impress  upon  the  reader  the  fact,  that  these  peculiar  states  of  tongue 
may  be  present  with  inflammatory  conditions  of  the  stomach,  of 
which  they  are  commonly  the  only  strongly  marked  symptoms.  A 
peculiar  sensibility  of  the  tongue  is  sometimes  indicative  of  gastric 
disease.  I  know  a  lady,  in  whom  attacks  of  gastric  inflammation  are 
manifested  by  a  peculiarly  sensible  and  painful  state  of  the  tongue, 
accompanied  by  an  itching,  which  is  extremely  distressing.  In  a 
second  lady,  severe  attacks  of  vomiting,  attended  with  all  the  phe- 
nomena of  inflammatory  action,  accelerated  pulse,  heat  of  skin,  and 
tenderness  of  the  epigastrium,  were  preceded  and  accompanied  by 
an  exalted  state  of  sensibility  in  the  tongue  and  a  constant  sensation 
of  pricking.  In  both  these  latter  cases  the  tongue  was  moist  and 
clean. 

In  all  these  instances  we  find  the  same  state  of  disease  manifested 
by  symptoms  which  are  of  various  kinds,  even  in  the  same  organ, 
proving  that  no  system  of  nosology  can  give  proper  ideas  of  disease. 
So  different  are  the  susceptibilities  of  different  organs,  that  we  find 


26  PARKER  ON  THE  STOMACH. 

the  evidences  of  chronic  gastritis  sometimes  in  one  organ,  sometimes 
in  another;  occasionally  they  are  marked  by  depraved  sensations 
of  various  kinds,  and  sometimes  entirely  unaccompanied  by  pain. 
Not  only  are  the  symptoms  of  stomach  disease  sometimes  found  in 
one  organ,  and  sometimes  in  another,  but  the  kind  of  morbid  con- 
dition in  the  same  organ  is  extremely  variable,  being  sometimes 
manifested  by  depraved  sensations,  and  again  by  various  forms  of 
inflammatory  action. 

A  long  and  close  attention  to  the  condition  of  the  tongue,  as 
affording  any  certain  da'ta  of  the  kind  or  degree  of  disease  existing 
in  the  stomach,  has  convinced  me  that  there  is  no  reliance  what- 
ever to  be  placed  upon  it,  considered  as  an  isolated  symptom. 
From  the  examination  of  a  number  of  cases  of  disease  of  the 
stomach,  accompanied,  as  all  inflammatory  affections  are,  with 
febrile  action  of  a  more  or  less  intense  character  I  must  concur  in 
the  deductions  made  by  Louis  on  the  state  of  this  organ  in  febrile 
and  inflammatory  affections  generally  ;  that  the  tongue,  like  all  other 
organs,  during  febrile  or  inflammatory  states  of  the  constitution,  is 
liable  to  attacks  of  inflammation,  which  give  to  it  its  various  mor- 
bid appearances.1  I  have  shown,  in  many  parts  of  this  work,  the 
truth  of  another  point,  (first  established  by  Louis,)  that  the  stomach, 
during  general  states  of  feverish  disturbance,  is  liable  to  become 
inflamed,  but  not  necessarily  so :  the  same  remark  applies  to  the 
tongue. 

CASE  2. — A  lady,  aged  thirty-six,  had  symptoms  of  gastric  dis- 
ease for  two  years,  during  which  time  the  tongue  was  never  red, 
but  always  pale,  moist,  and  very  slightly  coated.  Death  at  the  end 
of  this  period,  from  ulceration  of  the  lining  membrane  of  the  heart. 
Pyloric  portion  of  the  stomach  intensely  red,  covered  with  patches 
of  red  points ;  cardiac  portion  studded  with  small  red  clusters  of 
points,  in  the  centre  of  which  the  mucous  membrane  was  softened. 

CASE  3. — A  youth,  aged  twenty,  had  symptoms  of  chronic 
gastytis  for  many  months.  The  tongue  was  pale,  moist,  and 
slightly  coated  in  the  centre.  Death  from  acute  peritonitis.  The 
cardiac  portion  of  the  stomach  was  inflamed  and  softened,  for  a 
space  as  large  as  the  open  hand. 

CASE  4. — "A  girl,  aged  twenty,  died  from  typhus  fever.  The 
stomach  was  inflamed  and  softened,  but  the  tongue  moist,  contracted, 
and  pale."2 

In  many  of  the  cases  detailed  by  Louis,  the  tongue  did  not  differ 
from  its  healthy  state,  whilst  the  mucous  membrane  of  the  stomach 
was  inflamed  or  softened. 

In  some  of  the  cases  collected  by  Andral3  of  the  terminations  of 


1  La  derniere  consequence  des  fails  rapportes,  c'est,  qu'on  ne  doit  examiner 
la  langue  que  pour  ellejneme,  et  non  pour  connaitre  1'etat  de  la  membrane 
muqueuse  de  1'estomac. — Louis,  Op.  cit.  tome  ii.,  p.  106. 

*  Louis,  Observation  the  Fifth. 

8  Clinique  Medicale. 


INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH. 

chronic  gastritis  in  scirrhus,  or  thickening  of  the  coats  of  the 
stomach,  the  tongue  did  not  deviate  from  its  naturally  healthy 
state. 

If  we  carry  our  observations  on  the  state  of  the  tongue  to  cases 
of  the  milder  forms  of  stomach  disease,  we  shall  notice  such  affec- 
tions, of  great  intensity,  where  the  tongue  presents  little  or  no 
deviation  from  the  healthy  state.  I  have  now  under  my  care  two 
patients  who  have  been  the  subjects  of  chronic  diseases  of  the 
stomach  for  several  years,  in  whom  emaciation  has  slowly  pro- 
gressed, who  have  defined  tumours  in  the  epigastrium,  but  in  both 
of  whom  there  is  not  the  slightest  morbid  condition  of  the  tongue. 

We  have  a  second  series  of  cases,  in  which  morbid  states  of  the 
tongue,  of  an  inflammatory  kind,  are  met  with;  and  on  examination 
after  death  the  stomach  is  found  free  from  all  appreciable  disease. 

CASE  5. — A  gentleman,  aged  forty,  had  symptoms  of  gastric  dis- 
ease for  many  years,  which  consisted  in  daily  vomiting  of  food  both 
solid  and  fluid,  in  an  intensely  acid  state  ;  he  had  considerable  pain 
and  tenderness  in  the  epigastrium,  with  a  tongue  vividly  red, 
shining  and  smooth.  He  subsequently  died  of  disease  of  the  lung, 
the  gastric  symptoms  continuing-  even,  under  an  aggravated  form 
up  to  (he  period  of  dissolution.  The  stomach  was  free,  in  all  points, 
from  the  least  appearance  of  disease. 

"  We  have  observed  some  persons,"  says  Andral,  "  who  for  several 
months  in  succession,  presented  such  a  state  of  tongue  :  they  had  all 
the  other  signs  characteristic  of  chronic  gastritis.  But  this  appear- 
ance of  the  tongue  alone  should  not  suffice  to  cause  us  to  admit  its 
existence:  from  time  to  time  persons  are  met  with  who,  without 
experiencing  any  disturbance  in  their  digestive  functions,  have,  like 
the  preceding,  a  red  and  smooth  tongue."1 

The  third  series  of  facts  are  those  in  which  an  inflammatory  state 
of  the  tongue  co-exists  with  the  same  disease  in  the  stomach. 

CASE  6. — A  lady,  aged  53,  had  suffered  from  symptoms  of  chronic 
gastritis  for  twenty-five  years.  She  had  constantly  a  smooth  dry 
tongue  of  a  deep  red  colour.  On  examination  after  death,  which 
took  place  from  prolonged  gastric  disease,  the  cardiac  portion  of  the 
stomach  was  intensely  red,  presenting  one  uniform  surface  of 
inflammation,  covered  with  a  bloody  mucus. 

CASE  7. — A  lady,  aged  forty,  was  subject  to  pain  after  food,  with 
daily  vomiting,  for  three  years.  The  tongue  was  of  a  smooth, 
shining  red,  perfectly  dry,  the  redness  most  marked  at.  the  point 
and  edges.  On  examination  after  death,  the  whole  mucous  surface 
of  the  stomach  presented  a  pink  appearance;  in  some  places  there 
were  patches  of  a  deep  red  colour,  consisting  entirely  of  minute 
blood-vessels. 

These  series  of  facts  show  how  uncertain  are  the  data  afforded 
by  the  state  of  the  tongue  in  confirmed  organic  disease  of  the 
stomach.  In  the  earlier  stages  of  disease,  in  which  there  is  mere 

1  Op.  cit. 


28  PARKER  ON  THE  STOMACH. 

fulness  of  blood,  or  slight  irritation  unconnected  with  confirmed  in- 
flammatory disease  or  its  terminations,  the  state  of  tongue  is  as 
variable  as  in  the  circumstances  just  mentioned. 

One  condition  of  the  tongue  may  be  here  alluded  to,  which  is 
almost  invariably  an  index  of  gastric  irritation,  of  an  inflammatory 
kind.  It  is  when  this  organ,  not  materially  changed  in  other  cir- 
cumstances, presents,  at  the  point  and  edges,  a  number  of  vividly 
red  points.  These  resemble  grains  of  vermillion  scattered  over  the 
tongue.  They  appear  to  be  the  papillae  enlarged,  and  supplied  with 
an  increased  quantity  of  blood.  When  there  is  any  coating  upon 
the  tongue,  the  brilliant  papillae  are  seen  uncovered  by  it.  I  believe 
this  condition  is  seldom  found  unaccompanied  by  vascular  irritation 
of  the  stomach.  When  it  is  met  with  in  persons  who  do  not  offer 
any  symptoms  of  stomach  derangement  at  the  time  we  may  always 
con-elude  that  there  is  a  strong  predisposition  to  it,  and  that  a  very 
slight  cause  is  capable  of  producing  gastric  disturbance. 

OF    THE    SYMPTOMS    REFERABLE    MORE    PARTICULARLY    TO    THE 
STOMACH     ITSELF. 

The  evidences  of  diseases,  in  all  organs,  are  principally  to  be 
sought  for  in  the  derangements  of  those  functions  which  are  proper 
to  them  in  a  state  of  health,  and  the  degree  of  constitutional  dis- 
turbance which  accompanies  such  derangements.  In  inflammatory 
diseases  of  the  stomach  and  their  terminations,  the  first  are  chiefly 
loss  of  appetite  and  an  impaired  state  of  the  function  of  digestion, 
remarked  in  pain,  distension,  anomalous  nervous  symptoms,  nausea, 
and  vomiting.  In  many  cases  of  chronic  gastritis  there  is  ttle 
alteration  in  the  appetite,  and  the  patients  fancy  the  degree  of  dis- 
ease cannot  be  very  great  whilst  the  appetite  continues  so  good.  If 
the  whole  surface,  or  a  greater  portion  of  the  surface,  of  the  mucous 
membrane  be  affected,  there  is  total  loss  of  appetite  ;  but  if  the  dis--. 
ease  be  partial,  as  it  most  commonly  is,  and  the  inflammation  con- 
fined to  patches  of  the  mucous  membrane,  the  appetite  experiences 
but  little  alteration.  Although  the  appetite  continue  good,  the 
patient  undergoes  various  inconveniences  from  attempting  to  satisfy 
it;  he  is  tormented  with  flatulence  during  digestion,  feeling,  after 
having  taken  but  a  small  portion  of  food,  as  though  he  had  eaten  a 
full  rneal,  from  the  degree  of  distension  which  it  produces.  At  other 
times  this  distension  mounts  to  the  throat,  and  the  sufferer  is 
annoyed  by  a  sense  of  choking  amounting  to  suffocation.  At  one 
time,  a  burning  heat  follows  a  meal,  at  others,  acute,  lancinating 
pain,  the  seat  of  which  is  variable;  and  again,  a  degree  of  uneasiness 
is  produced,  which  is  not  appeased  till  trie  whole  of  the  food  taken 
has  been  rejected.  At  other  periods,  indescribable  feelings  of  sinking 
and  depression  are  experienced  in  the  neighbourhood  of  the  stomach. 
AVhen  the  epigastrium  is  pressed  these  feelings  are  sometimes 
brought  on  or  aggravated.  They  are  sometimes  relieved  for  a  short 


INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH.  29 

time  by  taking  food ;  at  other  times  they  are  immediately  aggravated 
by  it. 

A  lady  under  my  care,  with  chronic  gastritis,  had  a  sense  of  some 
impending  evil  about  to  befall  her,  with  sinking  and  fainlness  every 
time  the  gastric  symptoms  became  aggravated. 

The  evils  experienced  on  taking  food  during  the  continuance  of 
chronic  gastritis,  are  variable. 

A  gentleman,  aged  thirty-eight,  had  laboured  under  chronic 
gastritis  for  three  months.  He  had  vomiting  of  food  daily,  with 
great  acidity,  and  internal  heat  "  as  hot  as  a  hot  iron,"  to  use  his 
own  expression. 

A  second  gentleman  had  laboured  under  the  symptoms  of  chronic 
gastritis  for  many  months.  He  had  very  acute  pains  after  taking 
food,  which  were  not  appeased  till  the  food  was  rejected.  The  pain 
was  seated  in  the  centre  of  the  epigastrium. 

The  seat  of  pain  occurring  in  chronic  gastritis,  is  not  always  the 
same.  It  may  be  felt  in  the  throat,  in  the  centre  of  the  sternum,  on 
various  points  of  the  surface  of  the  chest,  under  the  prominences 
of  the  ribs,  on  either  side,  or  in  the  dorsal  portion  of  the  spine,  or 
under  the  scapulae. 

The  most  common  seat  of  pain  is  the  centre  of  the  epigastrium 
itself;  varying  from  mere  uneasiness  to  a  dull  constant  aching, 
increased  to  acute  lancinating  pain  on  the  aggravation  of  the  gastric 
symptoms,  or  from  irritating  or  stimulating  diet. 

In  a  second  form,  the  pain  is  referred  to  the  centre  of  the  sternum,1 
<>nd  is  supposed  by  many  to  indicate  some  affection  of  the  chest, 
especially  when  accompanied,  as  it  sometimes  is,  by  cough  or 
quickened  breathing. 

In  some  instances  the  pain  is  felt  in  the  throat,  and  when  swal- 
lowing, accompanied  at  the  same  time  with  uneasiness  in  the  region 
of  the  stomach,  shooting  to  the  centre  of  the  back  or  under  the  left 
shoulder.  These  symptoms,  in  the  opinion  of  Broussais,  indicate 
the  localisation  of  the  disease  in  the  cardiac  portion  of  the  stomach. 

A  lady,  aged  twenty-six,  had  suffered  from  daily  vomiting  of  food 
for  two  years.  Great  distension,  acidity,  and  pain,  followed  each 
meal.  The  more  prominent  features  of  her  complaint,  however, 
consisted  in  pain  in  the  throat  when  she  swallowed,  and  pain  also 
in  the  centre  of  the  back,  between  the  scapulas.  She  had  also  con- 
siderable tenderness  in  the  epigastrium,  aggravated  to  a  great  degree 
by  pressure.  The  disease  was  removed  altogether,  in  a  short  time, 
by  leeches,  and  blisters  applied  to  the  epigastrium  and  dorsal  por- 
tion of  the  spine,  with  some  attention  to  diet,  and  the  use  of  internal 
remedies  mentioned  in  the  chapter  on  treatment. 

The  pains  which   accompany  inflammatory  conditions  of  the 


1  On  en  voit  qui  eprouvent  des  donleurs  fortes  dans  toute  le  thorax  ou  au 
moins  dans  sa  moite  inferieure.  *  *  La  sensation  est  autant  rapportee  a 
la  peau  du  thorax  qu'a  1'estomac.— Broussais,  Cours  de  Pathologic,  tome  ii., 


30  PARKER  ON  THE  STOMACH. 

stomach  are  not  necessarily  felt  in  the  stomach  itself,  neither  is  pain 
a  pathognomonic  symptom  of  the  disease.  "  Chronic  inflammation 
of  the  stomach  is  not  necessarily  acornpanied  with  pain  in  the 
region  of  the  suffering  organ."1  We  commonly  find  it  seated  on 
various  points  of  the  upper  part  of  the  abdomen ;  sometimes  evidenced 
by  a  sense  of  constriction,  or  binding;  at  other  times  by  stinging, 
lancinating  pains  felt  as  low  as  the  umbilicus,  in  the  belly,  or  in 
the  chest,  upwards  as  far  as  the  mammae,  but  this  more  particularly 
on  the  left  side. 

CASE  8. — A  gentleman,  suffering  from  all  the  symptoms  of  chro- 
nic gastritis,  had  acute,  lancinating  pains,  radiating  from  the  centre 
of  the  epigastrium  over  the  left  side  of  the  chest  as  high  as  the  left 
mamma.  These  were  all  the  local  pains  he  suffered. 

CASE  9. — A  second  gentleman,  whose  gastric  disease  was  evi- 
dently produced  by  an  affection  of  the  heart,  had  a  sensation  of 
binding,  as  though  a  string  had  been  tied  tightly  round  his  waist, 
after  taking  a  moderate  meal. 

It  is  very  common  to  find  patients  complaining  of  pain,  some- 
times constant  and  fixed,  at  other  times  accompanying  or  following 
a  meal,  deep  under  the  ribs,  in  the  left  hypochondrium ;  with  this 
pain  co-exist  all  the  other  more  marked  symptoms  of  chronic  gastri- 
tis, though  tenderness  in  the  epigastrium  is  absent.  The  pain  which 
is  seated  under  the  ribs  in  the  left  hypochondrium,  is  dependent 
upon  disease  localised  in  the  greater  curvature  of  the  stomach.  It 
is  very  commonly  met  with  in  free  livers,  and  is  sometimes  accom- 
panied with  a  congested  state  of  the  spleen,  so  great  that  a  distinct 
tumefaction  is  discoverable.  In  many  cases  of  examination  after 
death  from  chronic  gastritis,  the  spleen  is  found  much  enlarged, 
and  united,  by  strong  adhesions,  to  the  stomach.  I  have  reported 
one  or  two  examples  of  it.  "Ce  gastrite  se  decele  par  une  douleur 
profonde  dans  la  region  de  la  rate  sous  I'hypochondre  gauche. 
La  douleur  qui  Paccompagne  est  fort  incommode  pendant  plusieurs 
heures,  et  plus  violente  lorsqne  les  alimens  commencent  d'etre  dans 
un  etat  de  coction  avancee."2 

The  pain  which  is  felt  in  the  centre  of  the  epigastrium  is  the 
most  common  of  all,  though  by  no  means  pathognomonic  of  a  dis- 
eased condition  of  the  mucous  coat  of  the  stomach.3  It  is  the  most 
common  for  two  reasons*:  1st.  Because  the  pyloric  portion  of  the 
stomach,  here  situated,  is  generally  the  most  frequent  seat  of  in- 
flammatory disease;  and  2dly.  Owing  to  the  exalted  sensibility  of 
the  great  nervous  centres  of  the  epigastrium,  which  generally  accom- 
panies an  inflamed  state  of  the  mucous  coat  of  this  organ.  We 
have  sympathetic  pains  accompanying  inflammation  of  the  mucous 
coat  of  the  pyloric  portion,  shooting  into  the  region  of  the  liver, 

1  Andral,  Op.  cit. 

'Broussais,  Cours  de  Pathologic,  tome  ii.,  p.  76. 

3  La  sensibilite  est  variable  suivante  les  individus;  les  uns  en  eprouvenl 
une  tres  vive  a  la  region  de  1'epigastre,  et  les  autres  n'en  emprouvent  aucune. 
Broussais,  Op.  cit. 


INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH.  31 

under  the  rigfht  scapula,  and  to  different  parts  of  the  right  side  of 
the  chest.  These  pains  are  very  likely  to  mislead,  and  to  make  us 
suspect  a  diseased  condition  of  the  liver,  if  we  are  not  very  careful 
in  our  examinaton  of  the  state  of  the  patient. 

One  of  the  most  common  symptoms,  attendant  on  an  inflamed 
condition  of  the  stomach,  is  distension,  fulness,  or  flatulence,  ac- 
companying or  immediately  succeeding  a  meal.  It  is  very  common 
to  meet  with  patients  in  whom  the  appetite  is  good,  but  who  are 
totally  unable  to  satisfy  it,  from  the  degree  of  distension  and 
oppression  which  are  consequent  upon  eating.  Sometimes  the  ful- 
ness is  felt  in  the  throat,  at  others  in  the  region  of  the  stomach 
itself;  patients,  to  relieve  themselves  from  the  state  of  distress  and 
inconvenience  under  which  they  labour,  are  obliged  to  slacken  their 
clothing,  unbutton  their  waistcoats,  or  unlace  their  stays.  It  is  not 
after  a  full  or  over-hearty  meal  that  these  symptoms  come  on,  but 
occasionally  after  having  taken  the  smallest  quantity  of  food.  This 
state  of  distension  is  particularly  marked  and  frequent  where  the 
gastric  disease  is  consequent  upon  an  affection  of  the  heart.  I  have 
two  gentlemen  now  under  my  care,  in  whom  this  was  the  first  and 
chief  symptom  attracting  their  attention. 

Although  chronic  vomiting  may  depend  upon  various  pathologic 
states  of  the  stomach,  as  also  upon  diseases  in  other  organs,  without 
any  affection  of  the  stomach  itself,  still  it  is  sometimes  the  only  symp- 
tom indicative  of  an  inflamed  condition  of  this  part.  I  have  frequently 
had  patients  brought  to  me,  in  whom  the  principal  complaint  was 
that  they  could  not  retain  their  food.  They  have  had  with  this 
other  symptoms  of  partial  gastritis,  as  a  dry,  coated  tongue,  heat 
and  tenderness  in  the  epigastrium,  headach,  and  thirst.  Many 
cases  had  been  present  for  three,  six,  and  more  months,  and  some 
had  lasted  for  two  or  three  years.  In  the  opinion  of  Andral, 
vomiting,  as  a  symptom  of  an  inflamed  condition  of  the  mucous 
membrane  of  the  stomach  or  its  terminations,  occurs  principally  in 
two  states  ;  where  a  chronic  state  assumes  the  acute  type,  or  where 
an  obstacle  is  offered  to  the  free  passage  of  the  food,  either  in  its 
entrance  to,  or  exit  from,  the  stomach.  It  is  certainly  not  attendant 
on  all  cases  of  gastritis,  but  occurs  in  many,  both  in  its  primary 
stages,  where  the  mucous  membrane  is  turgid  with  blood  and 
the  general  sensibility  exalted,  and  in  its  terminations  also,  where 
the  mucous  membrane  presents  alterations  either  of  colour  or  consist- 
ence. In  the  earlier  stages  of  inflammatory  diseases  of  the  stomach 
vomiting  is  a  much  more  common  symptom  than  it  is  in  the  more 
confirmed  and  chronic  condition. 

A  lady,  aged  eighteen,  was  brought  to  me,  who  had  daily  vomited 
all  her  meals  for  six  months ;  her  stomach  had  absolutely  retained 
nothing.  She  had  tenderness  and  heat  in  the  epigastrium,  but 
scarcely  any  other  symptom  indicating  an  inflammatory  condition 
of  the  stomach. 

Many  such  examples,  which  are  not  uncommon,  might  be 
adduced.  Occasionally  vomiting  is  the  only  symptom  present,  and 


32  PARKER  ON  THE  STOMACH. 

takes  place,  without  pain  being  produced,  at  an  earlier  or  later  period 
after  meals,  varying  from  one  to  six  hours.  At  other  times  vomiting 
is  accompanied  by  internal  pain,  shooting  to  various  parts  of  the 
abdominal  or  thoracic  parietes,  according  to  the  seat  and  extent  of 
the  disease. 

After  the  more  acute  symptoms  of  inflammatory  disease  of  the 
stomach  have  subsided,  arid  the  confirmed  chronic  state  alone  is 
present,  vomiting  is  not  so  common  ;  whilst,  after  the  terminations 
of  such  disease  in  change  of  structure,  we  commonly  find  this 
symptom  reappear  with  great  intensity.1  Vomiting,  as  a  symptom 
of  chronic  gastritis,  is  more  common  at  the  commencement  and  at 
the  termination  of  disease.  We  very  commonly  see  intense  vomit- 
ing set  in  at  the  termination  of  chronic  diseases  of  the  stomach, 
where  change  of  structure  has  taken  place  from  the  long  continu- 
ance of  insidious  inflammatory  action.  The  matters  vomited  may 
consist  of  blood,  food,  or  bilious  matters. 

CASE  10. — A  gentleman  had  laboured  under  the  symptoms  of 
chronic  gastritis  for  two  years,  the  prominent  feature  of  which 
consisted  in  great  pain  after  food,  shooting  to  the  back  and  over  the 
sides  of  the  chest ;  indeed,  from  the  pain  he  was  never  entirely 
free.  During  the  latter  weeks  of  disease  he  vomited  small  quantities 
of  blood,  and  suddenly  a  large  quantity,  soon  after  which  he  died.2 
A  mass  of  fungoid  vegetations  were  found  in  the  pyloric  portion  of 
the  stomach,  the  whole  of  the  mucous  membrane  being  reddened, 
at  intervals,  in  patches. 

In  this  case  pain  was  the  chief  symptom  present,  vomiting  not 
coming  on  till  the  latter  periods  of  disease. 

CASE  11. — A  middle-aged  lady  had  suffered,  for  some  time,  great 
pain  after  her  meals ;  at  length  a  vomiting  set  in,  which  was  in- 
controllable.  No  medicines  afforded  any  relief.  On  examination 
after  death  the  mucous  membrane  was  found  covered  by  several 
slate-coloured  patches,  about  the  size  of  a  half-crown  piece.  We 
commonly  find  vomiting  take  place  during  the  progress  of  inflam- 
matory diseases  of  the  stomach,  where  the  symptoms  become  aggra- 
vated from  errors  in  diet  or  other  causes,  and  the  affection  passes 
to  a  more  acute  stage,  in  which  also  the  nervous  irritability  of 
the  stomach  becomes  much  more  exalted.  This  is  very  often  met 
with  in  those  cases  where  chronic  gastritis  is  associated  with  dis- 
eases of  the  liver,  as  it  so  frequently  is.  In  such  instances  the 
stomach  affection  is  constantly  assuming  the  acute  or  sub-acute 
type,  and  vomiting  comes  on ;  whilst  in  subsiding  to  the  mere 
chronic  form  again  this  symptom  ceases,  although  the  inflammatory 
action  still  remains. 

1  have  now  under  my  care  four  patients  with  distinct  and  large 

•Chez  quelques  malades  les  vomissements  durent  autant  que  la  maladie; 
chez  quelques  autres  ils  n'ont  lieu  qu'au  debut,  chez  d'autres  au  contraire, 
qu'a  la  fin. — Andral,  Cours  de  Pathologie  Interne,  tome  i.,  p.  62. 

2  Q,uelque  fois  du  sans:  est  rejecte  vers  la  fin  de  la  gastrite  chronique,  c'est 
alors  un  signe  de  mort  prochaine. — Andral,  Op.  cit.,  p.  62. 


INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH.  33 

hepatic  tumours,  with  which  are  associated  all  the  symptoms  of 
chronic  gastritis.  In  these  cases,  although  the  disease  may  remain 
latent  for  a  time,  there  is  a  constant  tendency  to  assume  the  acute 
type,  which  is  invariably  accompanied  by  vomiting. 

Vomiting  taken  as  an  isolated  symptom,  is  by  no  means  indica- 
tive of  an  inflamed  condition  of  the  mucous  coat  of  the  stomach; 
in  conjunction  with  others,  it  demands  great  attention.  In  chronic 
gastritis,  as  I  have  said,  it  occurs  chiefly  when  this  is  passing  into 
the  more  acute  forms,  or  when  organic  change  exists  either  in  the 
cardia  or  pylorus. 

Vomiting  of  bile,  food,  and  various  discoloured  secretions,  may 
take  place  from  the  stomach,  consequent  upon  disease  in  other 
organs,  the  stomach  remaining  healthy.  These  are  chiefly  to  be 
ranked  among  lesions  of  the  nervous  influence  of  the  stomach.  It 
must  be  here  remarked,  however,  that  protracted  functional  derange- 
ments may  terminate  in  organic  changes,  which  are  attributed  to 
inflammatory  action,  although  none  of  the  symptoms  of  inflamma- 
tory action  are  at  first  in  existence.  In  fact,  those  which  are  called 
functional  derangements,  are  very  commonly  the  first  symptoms  of 
an  organic  change  which  is,  perhaps,  already  commencing. 

The  Clinique  Medicate  contains  the  detail  of  the  case  of  a 
person  "  who,. from  his  eighteenth  to  his  thirty-seventh  year,  scarcely 
passed  a  summer  without  being  attacked  with  copious  vomiting  of 
bile,  and  alvine  evacuations  of  the  same  nature.  He,  for  some  days, 
felt  a  kind  of  general  indisposition  and  fatigue  :  he  lost  appetite,  the 
epigastrium  became  a  little  sensible  to  the  touch,  and  bilious  eva- 
cuations commenced ;  they  continued  for  two  or  three  days,  and 
then  his  health  was  restored.  In  all  the  other  seasons  of  the  year 
this  person  digested  his  food  well,  and  suffered  nothing  from  his 
stomach;  but  such  did  not  continue  to  be  the  case.  Towards  the 
thirty-sixth  year  of  his  age  his  stomach  began  to  be  permanently 
affected,  and  by  degrees  he  presented  all  the  symptoms  of  scirrhous 
pylorus."  This  is  a  very  good  example  of  the  mode  in  which 
repeated  attacks  of  gastritis  lay  the  foundation  for,  and  ultimately 
terminate  in,  organic  disease.  The  attack,  at  first  corning  on  from 
accidental  causes,  leaves  a  disposition  in  the  organ  to  its  recurrence 
on  the  application  of  slighter  exciting  causes  than  those  which  at 
first  produced  it,  the  mucous  membrane  remaining  in  a  state  to  be 
thrown  into  inflammatory  action  from  slight  dietetic  errors;  and 
hence  repeated  irritations  of  the  inflammatory  kind,  which  in  the 
intervals  leave  the  patient  apparently  free  from  complaint,  ultimately 
terminate  in  confirmed  organic  change. 

I  have  had  the  charge  of  several  patients  in  the  latter  stages  of 
gastric  diseases,  who  have  been  able  distinctly  to  trace  the  com- 
mencement of  their  complaints.  These  have  seldom  commenced 
before  the  age  of  twenty-five,  at  the  periods  when  they  had  begun 
the  habitual  use  of  a  fuller  and  more  stimulating  diet  than  that  of 
the  earlier  periods  of  life.  The  symptoms  with  which  they  were 
first  affected  were  those  of  simple  indigestion,  in  its  various  forms 
10— a  park  3 


34  PARKER  ON  THE  STOMACH. 

of  pain  or  distension  after  food,  nausea,  or  vomiting.  These  have 
ceased  at  intervals,  have  been  relieved  by  various  plans  of  treatment, 
but  have  shown  a  disposition  to  recur  at  longer  or  shorter  intervals 
from  dietetic  errors  or  excesses,  or  from  other  causes,  in  more  aggra- 
vated and  obstinate  forms  than  those  in  which  they  first  made  their 
appearance,  and  accompanied  by  sympathetic  irritations  in  the 
head,  heart,  liver,  or  lungs,  exhibited  in  the  forms  of  giddiness, 
palpitations,  jaundice,  or  cough. 

On  examining  the  bodies  of  such  patients  after  death,  what  has 
been  the  condition  of  the  organs  exhibiting  these  symptoms  during 
life?  In  the  stomach,  changes  of  colour  or  consistence,  ulcerations 
or  vegetations  ;  in  the  brain,  thickening  of  its  membranes,  effusions, 
increased  determinations  of  blood;  in  the  heart,  alterations  of  its 
internal  or  investing  membranes,  or,  what  is  more  common,  of  its 
muscular  structure ;  in  the  lungs,  congested,  or  inflamed  states  of 
the  bronchial  mucous  surfaces,  or  of  the  lungs  themselves;  and  in 
the  hepatic  system  a  diseased  condition  of  the  veins  or  substance 
of  the  liver,  alterations  of  colour  or  consistence,  and  various  morbid 
states  of  the  bile,  the  gall-bladder,  and  the  excretory  passages  of 
the  bile.  Many  of  the  patients  in  whom  dyspeptic  symptoms  have 
commenced  about  the  ages  of  twenty-five  or  thirty,  have  fallen 
victims  to  gastric  diseases,  and  their  complications  at  the  ages  of 
from  forty-five  to  fifty-five.  A  number  of  the  histories  of  these 
patients,  detailed  in  the  subsequent  pages  of  this  work,  have  been 
carefully  collected  from  the  sufferers  themselves ;  and  the  pathologic 
changes  their  organs  exhibited  have  been  ascertained  by  my  own 
dissections  after  death. 

The  internal  pain  experienced  in  purely  inflammatory  diseases 
of  the  stomach  is  generally  obscure,  unless  the  disease  be  associated 
with  a  degree  of  nervous  excitement  approaching,  in  some  measure, 
the  character  of  neuralgia.  This  organ  is  the  seat  of  two  morbid 
actions,  which  are  attended  by  pain;  each  of  which  may  be  in 
existence  without  the  other,  or  they  may  be  associated  during  the 
progress  of  disease.  These  are  vascular  irritations  or  inflammations, 
and  nervous  irritations;  when  the  excitement  is  confined  to  the 
nervous  capillaries  of  the  stomach,  it  is  called,  in  medical  language, 
erethism.  The  pain  which  attends  chronic  gastritis,  if  this  exist 
in  its  simple  state,  without  complication,  is  generally  dull  and 
obscure.  There  is  generally  in  this  disease  uneasiness  or  weight 
in  the  stomach,  which  is  occasionally  relieved  for  a  short  time  by 
taking  food,  but  the  pain  returns,  in  an  aggravated  form,  at  a  varia- 
ble period  of  time  after  eating.  Sometimes  immediate  pain  is  felt, 
again  it  is  mere  uneasiness  at  a  protracted  period  of  digestion,  and 
produced,  as  patients  will  often  inform  us,  by  the  food  touching  a 
sensitive  surface,  over  which  they  can  feel  it  passing. 

CASE  12. — A  gentleman,  suffering  from  the  ordinary  symptoms 
of  chronic  gastritis,  marked  by  pain  and  tenderness  in  the  epigas- 
trium and  left  hypochondrium.  with  distension,  weight,  flatulence, 
and  acidity  after  eating,  complained  to  me  of  a  sense  of  pain  or  pecu- 


INFLAMMATORY  AFFECTIONS  OF  THE  STOMACH.  35 

liar  uneasiness,  occurring  five  or  six  hours  after  a  meal,  when  he 
fancied  the  food  was  passing  over  a  surface  more  sensitive  than  the 
other  parts  of  the  stomach. 

In  this  case,  although  the  symptoms  of  inflammatory  disease  of 
the  stomach  were  strongly  marked,  there  is  mere  uneasiness  after  a 
meal  present. 

If  chronic  gastritis  occur  in  patients  where  the  nervous  system 
is  highly  irritable,  the  character  of  pain  occurring  after  taking  food 
is  sometimes  very  violent. 

CASE  13. — Violent  pain  succeeding  meals,  apparently  dependent  upon 
chronic  gastritis. 

A  lady,  aged  forty-three,  had  been  subject  to  attacks  of  pain  after 
food,  with  occasional  vomiting,  for  fifteen  years ;  the  attacks  were 
generally  brought  on  by  mental  uneasiness.  For  three  months 
preceding  my  first  attendance  upon  her  she  had  been  much  worse. 
At  the  time  of  my  first  visit  she  was  much  emacuted,  had  constant 
pain  in  the  stomach,  aggravated  to  such  an  extent  by  taking  food 
that  she  was  reduced  to  small  quantities  of  cold  gruel,  and  even 
this  occasioned  much  pain.  There  was  most  obstinate  constipation, 
with  a  dry,  red  tongue,  and  a  small,  rapid  pulse. 

The  pains  felt  after  food  in  this  patient  were  very  peculiar: 
sometimes  they  shot  into  the  mammae  most  acutely,  and  resembled 
pleurisy;  at  other  times  she  felt  as  though  some  one  were  scraping 
the  surfaces  of  the  ribs  in  the  hypochondria.  With  all  this  there 
was  no  sign  of  pectoral  disease,  corroborating  the  remark  of  Brous- 
sais,  that  we  must  not  attribute  all  the  pains  that  are  felt  in  the 
chest  to  a  diseased  condition  of  some  one  of  its  contained  organs. 

The  pain  was,  in  this  case,  not  a  nervous  affection  independent 
of,  and  merely  coinciding  with,  the  inflammatory  disease,  but  a 
state  of  irritability  strictly  dependent  upon,  and  produced  by,  the 
gastritis,  since  it  yielded  to  leeches,  counter-irritation,  and  warm 
aperients,  and  abated  in  the  same  degree  as  the  inflammation  which 
companied  it.  In  many  instances,  as  in  the  following,  we  shall  find 
that  this  is  not  the  case,  but  that  the  pain  becomes  more  acute  as 
the  symptoms  of  inflammation  are  less  so. 

CASE  14. — Nervous  affection  of  the  stomach  associated  with  inflammatory 
disease,  the  nervous  affection  remaining  after  the  inflammation  had 
subsided.  * 

A  gentleman  came  under  my  care  in  November,  1834,  labouring 
under  the  usual  symptoms  of  an  inflamed  condition  of  the  mucous 
membrane  of  the  stomach.  He  had  constantly  uneasy  sensations 
in  the  stomach,  which  were  considerably  increased  by  taking  food. 
He  had  occasional  vomiting1,  distension  after  food,  acid  eructations, 
with  heat  and  tenderness  in  the  epigastrium.  These  symptoms 
yielded  to  antiphlogistic  treatment,  and  all  the  symptoms  of  a  dis- 
eased condition  of  the  stomach  subsided,  with  the  exception  of  un- 


36  PARKER  ON  THE  STOMACH. 

easiness  after  food,  which  augmented,  as  the  inflammatory  affection 
disappeared,  to  violent  pain.  This  latter  symptom  was  aggravated 
by  all  antiphlogistic  treatment,  but  yielded  to  morphia  with  the 
salts  of  iron. 

In  this  instance,  we  observe  the  pain  accompanying  the  inflam- 
matory affection  obscure,  whilst  the  symptoms  of  inflammation 
remain ;  but  as  these  subside,  the  pain,  which  was  evidently  of  a 
nervous  character,  becomes  more  acute  and  only  yields  to  anodyne 
and  tonic  remedies.  The  character  of  the  pain,  becoming  worse 
as  inflammation  subsides,  and  the  effects  of  the  remedies  employed, 
at  once  stamp  it  as  a  disease  distinct  from  inflammation,  although 
associated  with  it.  The  fifth,  sixth,  and  eighth  cases  in  my  paper 
"On  Diseases  of  the  Stomach,"  in  the  Dublin  Medical  Journal, 
are  examples  of  this  association  of  neuralgic  pains  in  the  stomach, 
which  sometimes  accompany,  and  sometimes  succeed  to,  inflamma- 
tion. Whether  these  pains  are  the  consequence  of  inflammatory 
action  or  not,  is  a  difficult  question  to  determine. 

It  is  a  common  circumstance  to  observe,  during  the  progress  of 
diseases  of  the  stomach,  two  distinct  species  of  irritation  in  it  at  the 
same  time :  one  the  consequence  of  inflammation,  the  second  de- 
pending upon  an  unduly  excited  state  of  the  nervous  system  in  the 
same  organ.  Sometimes  the  nervous  symptoms  are  associated  with 
the  inflammatory;  in  other  instances  they  succeed  to  them,  becom- 
ing more  severe  as  the  inflammatory  irritation  subsides.  In  a  third 
form  inflammation  comes  on  after  a  long  continuance  of  the  nervous 
affection.  Barras  relates  two  remarkable  cases  of  this  kind  in  his 
Treatise  on  the  Nervous  Affections  of  the  Stomach  and  Bowels. 
The  concurrent  testimony  of  Louyer  Villermay,  Barras,  and  Goul- 
tier  de  Claubry,  at  once  prove  the  existence  of  nervous  and  inflam- 
matory irritations  in  the  stomach  at  the  same  time.1 


CHAPTER  V. 

ON  AFFECTIONS  OF  THE  STOMACH  CHARACTERISED  BY  DERANGE- 
MENTS OF  ITS  SENSIBILITY. 

I  have  shown,  in  the  preceding  chapter,  that  the  characters  of 
pain  attendant  upon  inflammatory  conditions  of  the  stomach  are 
extremely  variable,  being  sometimes  obscure,  at  others  violent, 
bearing  no  strict  relation  to  the  character  or  degree  of  that  inflam- 

1  La  gastrite  peut  se  rencontrer  avec  1'exaltation  de  le  sensibilite  nerveuse 
de  I'estomac. — Barras,  p.  607.  II  est  des  circonstances  ou  cette  phlegmasie 
est  primitive  et  1'exaltation  nerveuse  secondaire  ;  mais  la  maladie  sort  alors 
de  la  classe  des  nevroses  pour  rentrer  dans  celle  des  inflammations;  c'est 
une  gastrite  compliquee  de  phenomenes  nerveux. — Barras,  Op.  cit.,  p.  608. 


DERANGEMENTS  OF  ITS  SENSIBILITY.  37 

mation  upon  which  they  depend,  or  with  which  they  are  associated. 
There  are  many  diseases  of  the  stomach  which  consist  in  a  purely 
morbid  state  of  the  sensibility  of  the  gastric  nerves,  without  the 
association  of  any  inflammatory  action  ;  these  have  been  well 
described  by  Dr.  James  Johnson,  in  his  work  on  the  Morbid  Sen- 
sibility of  the  Stomach  and  Bowels,  and  into  their  primary  forms  I 
consider  it  unnecessary  to  enter,  referring  my  readers  to  that  book 
for  information  on  these  points. 

M.  Barras  has  produced  a  work  of  some  merit,  entitled  Sur  les 
Gastralgies  et  les  Enteralgies,  or  Nervous  Diseases  of  the  Stomach 
and  Intestines.  A  careful  perusal  of  the  work  will,  however,  show 
that  many  of  the  cases  detailed  in  it  were  evidently  inflammatory 
in  their  commencement,  and  only  rendered  purely  nervous  by  the 
pernicious  system  of  large  local  depletions,  adopted  by  most  of  the 
French  physicians  of  the  physiologic  school,  acting  upon  the  apho- 
rism of  Broussais,  that  the  greater  part  of  all  indigestions,  in  what- 
ever form  they  are  exhibited,  are  due  to  a  chronic  inflammation  of 
the  mucous  coat  of  the  stomach.  M.  Barras  maintains,  merely  in 
opposition  to  M.  Broussais,  that  the  greater  part  of  these  affections 
are  of  a  nervous  kind,  and  dependent  altogether  upon  certain  and 
varied  states  of  depraved  sensation  in  the  gastric  and  intestinal 
nerves;  and  to  these  causes  he  refers  the  group  of  dyspeptic  symp- 
toms of  pain,  cramp,  spasm,  chronic  vomiting',  morbidly  increased, 
depraved,  or  defective  appetite,  and  other  symptoms  of  this  kind. 

The  truth,  however,  rests  neither  with  M.  Broussais  nor  M. 
Barras,  but  between  the  two.  There  are,  questionless,  certain  and 
frequent  forms  of  disease  in  the  stomach  which  terminate  fatally, 
in  which  no  organic  change  can  be  detected  in  the  stomach  or  in 
any  other  organ  connected  with  it,  and  which  can  be  referred  only 
to  a  diseased  condition  of  the  nervous  powers  of  the  stomach,  in 
which  the  function  of  chymification,  or  stomachal  digestion,  is 
destroyed,  or  so  much  impaired  as  not  to  be  able  to  support  life. 
Andral  has  detailed  a  remarkable  case  of  this  kind  : — 

CASE  1. — "A  female  aged  thirty-eight,  entered  the  hospital  of 
La  Pitie  labouring  under  the  following  symptoms: — A  total  want 
of  appetite,  which  had  continued  for  seven  or  eight  months  ;  every 
time  she  took  food  she  felt  an  insupportable  weight  in  the  region 
of  the  stomach,  and  occasionally  an  acute  pain.  From  time  to 
time  she  vomited  some  whitish  mucus.  Strong  pressure  on  the 
epigastrium  produced  no  painful  sensation  in  this  region.  The 
remainder  of  the  abdomen  was  soft  and  free  from  pain ;  the  patient 
was  habitually  constipated;  tongue  natural;  no  disturbance  of  any 
other  organ :  she  was  much  emaciated  and  very  feeble.  She  men- 
tioned that  the  appetite  began  to  fail  after  having  been  subjected  to 
severe  mental  distress. 

This  patient  was  considered,  by  her  medical  attendants,  to  be 
labouring  under  chronic  inflammatory  disease  of  the  stomach  ;  and 
from  the  clean  state  of  the  tongue,  cancerous  degeneration  of  its 
submucous  cellular  tissue  was  suspected.  A  seton  was  placed 


38  PARKER  ON  THE  STOMACH. 

over  the  epigastrium,  but  without  effect.  The  patient  wasted  away, 
and  died  without  presenting  any  new  symptoms.  On  examination 
after  death  the  stomach  was  found  perfectly  healthy;  its  nerves 
and  tissues  were  in  their  natural  condition.  None  of  the  other 
organs  of  the  body  presented  any  appreciable  deviation  from  their 
usual  healthy  condition. 

A  lady,  mentioned  by  Dr.  Abercromby.  had  constant  vomiting  of 
food  and  severe  pain  after  eating,  which  at  length  became  so  bad 
that  she  was  unable  to  retain  any  thing  upon  her  stomach,  except 
fluids  in  very  small  quantities.  No  treatment  afforded  relief,  except 
blisters  to  the  epigastrium.  She  gradually  wasted  and  died,  and 
on  examination  of  the  body  no  disease  could  be  detected,  except 
some  enlarged  glands  behind  the  stomach. 

These  two  cases  are  examples  of  disease  of  the  stomach  attended 
by  marked  symptoms  of  functional  derangement,  but  unaccom- 
panied by  any  appreciable  organic  lesion  upon  which  they  can  be 
said  to  depend.  We  observe  no  change  in  the  colour  or  consistence 
of  the  stomach  or  its  membranes;  its  nerves  and  tissues  appear  to 
be  in  the  most  perfectly  natural  condition :  yet  the  food  taken 
creates  pain,  is  rejected  by  vomiting,  and  the  patients  emaciate  and 
die.  We  certainly  must  suppose  that  these  symptoms  are  owing  to 
a  complete  loss  of  the  digestive  power  of  the  stomach,  depending 
upon  causes  we  cannot  appreciate.  In  some  instances,  we  observe 
affections  of  the  stomach,  of  this  character,  come  on,  which  are 
dependent  upon  disease  in  other  organs.  Here,  likewise,  all  the 
parts  entering  into  the  composition  of  the  stomach  are  found 
healthy. 

CASE  2. — A  middle-aged  lady  was  subject  to  occasional  attacks 
of  vomiting  and  pain  in  the  epigastrium,  of  a  very  severe  character, 
which  had  harassed  her  for  several  years.  At  times  her  stomach 
digested  well,  and  she  felt  no  inconvenience  from  eating;  at  others, 
the  food  taken  occasioned  great  pain  and  distension,  and  was  com- 
monly rejected  by  vomiting.  In  these  states  she  found  great  benefit 
from  leeches  and  blisters  to  the  epigastrium,  and  the  internal  admi- 
nistration of  mild  aperient  and  sedative  remedies.  After  the  con- 
tinuance of  this  affection,  with  little  variation,  for  many  years,  the 
patient  died  from  an  attack  of  acute  pleuro-pneumonia.  I  was 
most  anxious  to  have  an  opportunity  of  examining  the  condition  of 
the  lining  membrane  of  the  stomach,  which  had  exhibited  symp- 
toms of  disease  for  so  long  a  time.  On  laying  open  this  organ  I 
was  surprised  to  find  it  perfectly  healthy,  it  was  not  even  slightly 
injected ;  all  its  tissues  were  in  the  most  natural  state,  as  far  as 
anatomy  enabled  us  to  appreciate  them.  The  right  ovary,  however, 
was  converted  into  a  cyst,  containing  a  large  quantity  of  hair  and 
a  few  portions  of  bones. 

Affections  of  the  sensibility  of  the  stomach,  or  in  which  derange- 
ments of  the  sensibility  are  the  prominent  features  of  the  disease, 
may  be  either  acute  or  chronic,  and  evidenced  under  a  vast  variety 
of  forms.  Sometimes  they  are  of  long  standing,  and  are  attended, 


DERANGEMENTS  OF  ITS  SENSIBILITY.  39 

like  organic  diseases  generally,  by  progressive  wasting  of  the  body; 
at  other  times  they  come  on  suddenly,  yet  are  purely  nervous  dis- 
ease?, at  least  the  local  determination  of  blood  which  accompanies 
them  is  a  secondary  consideration.  They  are  also  accompanied  by 
sympathetic  irritations  in  other  organs,  which  are  of  the  same  pa- 
thologic character  as  those  existing  in  the  stomach.  In  many 
instances  they  perfectly  resemble  diseases  which  are  of  an  inflam- 
matory character,  yet  are  aggravated  by  a  treatment  exclusively 
antiphlogistic. 

It  is  very  common  for  these  affections  to  succeed  to  large  or 
repeated  hemorrhages,  of  which  I  have  given  several  examples  in 
the  second  chapter  of  this  work :  here  they  are  evidently  dependent 
upon  loss  of  tone  in  the  nervous  system,  due  to  a  want  of  its  pro- 
per stimulus — a  certain  quantity  of  healthy  arterial  blood.  In  such 
forms  they  are  best  and  most  speedily  cured  by  large  doses  of  the 
preparations  of  iron ;  the  carbonate  of  iron  with  the  powder  of 
calumba*ls  then  exceedingly  useful.  .1  have  seen  patients  restored 
very  quickly  by  such  remedies  where,  in  the  first  instance,  the 
affection  had  been  mistaken  for  an  inflammatory  one,  and  so 
treated. 

There  are  other  forms  of  disease,  in  which  derangements  of  the 
sensibility  are  the  prominent  features,  which  succeed  to  long-con- 
tinued indigestions  of  the  inflammatory  kind;  the  latter  have 
yielded  to  antiphlogistic  treatment,  but  the  patient  still  continues  to 
be  harassed  with  most  distressing  sensations  connected  with  his 
stomach,  under  the  forms  of  .pain  after  food,  distension,  nausea, 
vomiting,  uneasy  sensations  and  beatings  in  the  epigastrium,  with 
variable  conditions  of  the  bowels,  and  sympathetic  affections  of 
other  organs;  as  hurried  breathing  and  cough,  palpitations,  giddi- 
ness, a  copious  flow  of  thin  pale  urine,  or  one  scant  in  quantity 
and  loaded  with  amorphous  deposits.  Many  of  these  affections  are 
precisely  the  forms  of  disease  which  M.  Barras  has  described,  in 
his  work,  as  nervous  diseases  of  the  stomach  and  intestines,  and 
which  have  succeeded  to,  and  have  been  produced  by,  inflammatory 
affections  which  have  been  treated  by  large  losses  of  blood  from 
the  epigastrium.  I  have  had  many  patients  under  my  care  where, 
in  the  first  forms  of  complaint,  local  depletions  from  the  region  of 
the  stomach  have  afforded  vast  relief  in  conjunction  with  other 
remedies;  but  there  has  arrived  a  period  in  the  history  of  these  dis- 
eases where  leeches  have  ceased  to  afford  relief,  and  where,  in  fact, 
they  have  rather  aggravated  than  relieved  the  affection.  Sometimes 
the  nervous  affections,  which  succeed  to  the  inflammatory,  present 
nearly  the  same  symptoms  as  those  of  inflammation  ;  and  it  is 
merely  from  a  discovery  that  the  use  of  the  same  remedies  ceases 
to  afford  relief  that  we  are  made  aware  that  the  character  of  the 
disease  is  changed.  Again,  the  nervous  affection  is  characterised 
by  new  and  other  symptoms  than  those  which  were  present  in  the 
inflammatory  form.  Occasionally  the  character  of  pain  becomes 
changed;  it  is  more  acute,  or  various  acid  secretions  are  discharged 
from  the  mouth,  arid  the  affection  assumes  a  complexion  which 


40  PARKER  ON  THE  STOMACH. 

Andral  has  described  under  the  name  of  secretory  irritation,  or 
gastrorrhrea,  in  which  there  is  an  excessive  secretion  of  mucus 
from  the  lining  membrane  of  the  stomach. 

In  many  cases  of  diseases  of  the  stomach  we  find  affections  of  the 
sensibility  constantly  combined  with  inflammation,  even  on  the  first 
appearance  of  disease;  and  hence  many  symptoms  accompanying 
protracted  and  severe  forms  of  indigestion,  which  are  of  the  inflam- 
matory kind,  do  not  give  way  to  an  antiphlogistic  treatment.  This 
has  not  escaped  the  penetration  of  Andral,  when  he  tells  us  that 
"  many  of  the  symptoms  observed  during  the  progress  of  inflam- 
matory diseases  of  the  stomach,  such  as  nausea,  vomiting,  &c.,  are 
due  to  affections  of  the  sensibility."1 

In  practice,  these  remarks  are  found  of  vast  importance.  Thus, 
when  we  find  that  certain  forms  of  indigestion,  of  the  inflammatory 
character,  cease  to  be  relieved  by  antiphlogistic  treatment — the 
symptoms  continuing  in  almost  their  primitive  intensity,  or  perhaps 
even  more  acute — a  recourse  to  other  remedies  will  sometimes  at 
once  remove  them.  Here  combinations  of  the  salts  of  morphia  with 
those  of  iron,  of  bitters  and  chalybeates,  or  of  the  sub-nitrate  of  bis- 
muth with  magnesia,  will  be  of  the  greatest  service.  We  must  not 
suppose,  because  the  affection  has  not  yielded  to  antiphlogistic 
treatment  when  it  appeared  inflammatory  in  the  commencement, 
that  such  remedies  have  been  improper  or  useless.  These  have 
removed  the  inflammatory  action,  but  have  left  the  disease  of  sensi- 
bility remaining.  The  exhibition  of  tonic  medicines  before  the  use 
of  leeches  to  the  epigastrium  would,  in  all  probability,  have  con- 
siderably aggravated  the  disease. 

There  are  certain  affections  of  the  sensibility  of  the  stomach 
which  are  combined  with  inflammatory  action  from  the  commence- 
ment, and  in  which  a  combination  of  treatment  is  highly  successful. 
Thus,  patients  will  commonly  present  themselves  labouring  under 
nausea  and  pain  in  the  stomach,  with  great  distension  and 
acidity  after  eating;  with  these  symptoms  there  commonly  co-exist 
palpitations  and  pulsations  in  the  epigastrium,  with  heat,  pain, 
and  tenderness,  rolling  and  indescribable  feelings  of  uneasiness. 
Accompanying  these  states  there  is  frequently  hurried  breathing, 
considerable  arterial  excitement,  and  excessive  mental  distress.  The 
mental  affections,  in  such  conditions,  are  often  of  the  most  distress- 
ing character,  in  some  instances,  almost  approaching  to  the  insane 
state.  Many  cases  in  the  work  of  M.  Barras  are  of  this  description, 
and  several  of  those  in  my  paper  in  the  Dublin  Journal  are  of 
similar  character,  particularly  cases  eight,  nine,  ten;  eleven,  and 
twelve.  Whatever  may  be  the  primitive  character  of  such  diseases, 
there  is  evidently  local  determination  of  blood  to  the  parts  situated 
in  the  epigastric  region,  such  as  the  stomach,  and  the  great  nervous 
centres  immediately  behind  it. 

In  such  forms  of  disease  a  combination  of  treatment,  apparently 

1  See  Cours  de  Pathologic  Interne,  tome  i.,  p.  62. 


DERANGEMENTS  OF  ITS  SENSIBILITY.  41 

of  an  opposite  character,  is  the  most  certain  method  of  cure.  I  have 
seldom  seen  it  fail ;  I  have  seen  such  forms  of  disease  repeatedly 
aggravated  by  a  tonic  treatment,  or  by  an  antiphlogistic  one  sepa- 
rately employed.  I  have  seen  them  quickly  cured  by  applying 
small  numbers  of  leeches  to  the  epigastrium  from  time  to  time,  four 
or  six  at  each  application  ;  regulating  the  bowels  with  warm  aloetic 
aperients,  combined  with  morphia  and  prussic  acid  ;  at  the  same 
time  administering  freely  the  preparations  of  iron,  of  which  I  believe 
the  common  carbonate,  combined  with  calumba  powder,  to  be  the 
best. 

I  shall  detail  a  few  cases  of  such  forms  of  disease,  in  their  com- 
bination with  certain  local  determinations  of  blood  and  also  in  their 
forms  of  sympathetic  irritation  of  other  organs. 

CASE  4. — Gastrodynia — Pyrosis. 

I  was  consulted,  by  a  lady,  for  a  disease  characterised  by  the  fol- 
lowing symptoms :— Intense  heat  in  the  stomach  and  throat,  with 
pain  so  great,  on  taking  even  the  simpler  forms  of  food,  that  she  was 
unable  to  do  so  more  than  once  in  the  twenty-four  hours.  The 
affection  had  commenced,  some  months  back,  with  slight  uneasiness 
after  meals,  and  had  been  progressing  till  now,  in  spite  of  varied 
medical  treatment.  The  long  periods  of  .abstinence  from  food,  and 
the  imperfect  digestion  of  what  little  was  taken,  had  reduced  my 
patient  to  an  extreme  degree  of  emaciation  ;  her  weakness  was  great 
and  she  walked  with  much  difficulty.  The  local  pain  was  accom- 
panied by  regurgitations  of  sour  fluids  and  gases;  whatever  was 
taken  by  way  of  support  was  generally  vomited  intensely  sour. 
The  bowels  were  constipated,  which  always  added  to  the  existing 
complaints;  there  was  hardly  any  tenderness  on  pressing  the 
epigastrium,  but  this  region  appeared  rather  full  when  carefully 
examined.  Every  kind  of  medicine  hitherto  taken  had  increased 
the  pain  equally  with  aliment. 

A  blister  was  ordered  to  the  epigastrium,  and  half  a  dram  of  the 
ponderous  carbonate  of  magnesia  prepared  by  Henry,  of  Manchester, 
was  given  every  four  hours,  combined  with  ten  grains  of  calumba 
powder,  and  the  diet  was  limited  to  the  farinaceous  food  made  by 
Hards,  of  Dartford. 

8th.  The  first  powder  had  eased  the  pain  ;  to-day  there  is  much 
less ;  the  food  had  not  been  vomited,  and  had  given  no  pain.  No 
action  upon  the  bowels. 

9th.  Bowels  acted  upon  three  times.  All  the  symptoms  ame- 
liorated. 

llth.  Still  improving.  Animal  broths  and  chicken  are  taken 
with  tolerable  comfort,  but  the  bowels  not  having  been  acted  upon, 
and  the  head,  in  consequence,  affected,  I  ventured  to  prescribe  some 
aperient  medicine,  of  a  character  rather  more  active,  still  combining 
it  with  the  carbonates  of  soda  and  magnesia.  The  aperient  had 
produced  so  much  pain  that  it  was  obliged  to  be  laid  aside.  The 


42  PARKER  ON  THE  STOMACH. 

powders,  which  invariably  gave  relief,  were  again  taken,  with  a 
wine  glass  of  the  compound  decoction  of  aloes,  and  two  drops  of 
hydrocyanic  acid,  three  times  a  day. 

16th.  The  medicines  act  sufficiently,  and  cause  no  pain.  Boiled 
mutton  and  chicken  are  taken  with  but  a  trifling  degree  of  incon- 
venience. The  tongue  is  clean  :  she  has  gained  flesh  and  strength. 

Remarks. — It  is  evident,  on  examining  the  history  of  this  case, 
that  its  origin  is  to  be  traced  to*  morbid  irritability  of  the  nervous 
capillaries  of  the  stomach  ;  and  we  find  the  secretions  of  its  follicles 
and  lining  membrane  secondarily  becoming  disordered.  As  the 
secretions  of  all  parts  go  on  under  the  direction  of  the  nerves  supply- 
ing them,  it  follows  that  they  can  only  remain  healthy  as  long  as 
the  secreting  organ  is  supplied  with  its  due  proportion  of  nervous 
influence  in  its  normal  physiological  state ;  and  when  this  is  im- 
paired or  deranged,  is  in  excess  or  diminution,  over-excited  or  not 
sufficiently  sensible  to  stimulus,  a  corresponding  condition  of  morbid 
secretion  is  the  consequence.  After  long-continued  irritability  of 
the  stomach,  of  which  pain  after  meals  is  at  first  the  only  symptom, 
we  have  obstinate  pyrosis,  and  the  moment  the  pain  begins. the 
glairy  acid  fluid  will  begin  to  run  from  the  mouth ;  this  1  have 
commonly  seen.  In  some  cases,  there  is  such  a  disposition  to  the 
formation  of  acid  on  taking  food,  from  the  defective  quantity  or 
morbid  quality  of  the  secretions  of  the  stomach,  that  every  article 
of  diet,  whether  solid  or  fluid,  is  either  rejected  in  a  perfectly  acid 
state,  or  constantly  regurgitates  into  the  mouth  fluids  so  sour  as 
almost  to  disorganise  its  lining  membrane.  This  action  from  time 
to  time,  upon  the  coats  of  the  stomach,  at  length  renders  it  so  sen- 
sible that  it  is  unable  to  bear  either  the  impression  of  food  or  medi- 
cine, and  the  patient  if  not  speedily  relieved,  would  soon  fall  into  a 
state  of  disease  from  which  he  would  with  difficulty  recover.  The 
first  step  in  the  treatment  of  these  forms  of  disease  is  to  correct  the 
morbid  secretions  of  the  stomach,  and  for  this  purpose  no  medicine 
is  so  beneficial  as  Henry's  ponderous  carbonate  of  magnesia,  com- 
bined with  calumba  powder,  and  administered  in  the  way  I  have 
directed  ;  a  sixth  or  eighth  of  a  grain  of  the  acetate  or  muriate  of 
morphia  may  be  added,  or  from  ten  to  twenty  minims  of  the  liq. 
opii  sedativus,  dropped  into  the  vehicle  in  which  it  is  administered. 
I  am  convinced  that  every  thing  of  a  more  active  character  that  is 
employed  before  the  secretion  of  acid  is  corrected,  and  the  stomach 
rendered  less  sensible  to  impression,  only  aggravates  the  disease, 
and  renders  the  recovery  longer  and  more  tedious.  The  second 
step  in  the  treatment  consists  in  endeavouring  to  remove  the  dis- 
position to  the  formation  of  acid ;  this  I  shall  exemplify  in  the 
further  detail  of  this  case. 

March  29th.  The  pain  still  continues  in  a  milder  form,  and 
invariably  comes  on  after  taking  a  mixture  of  aliments  at  dinner. 
The  medicines  at  first  prescribed  invariably  relieve  the  pain  when 
it  occurs,  probably  by  merely  correcting  the  acid  secretions  which 
cause  it,  I  ordered  the  acetate  of  morphia  now  to  be  taken  in  doses 


DERANGEMENTS  OF  ITS  SENSIBILITY.  43 

of  a  sixth  of  a  grain,  three  times  a  day,  combined  with  four  of  rhu- 
barb ;  and  the  powders  to  be  taken  occasionally  in  the  event  of  an 
attack  of  pain  and  acidity. 

April  18th.  Since  the  last  report  there  has  been  no  pain,  except- 
ing on  one  day,  when,  at  a  dinner  party,  she  ate  freely  of  mixed  food 
and  green  vegetables,  and  drank  a  glass  of  sherry;  immediately 
after  the  meal,  sudden  swelling  of  the  stomach  took  place,  with  pain 
and  vomiting  of  sour  fluids.  In  order  perfectly  to  restore  my 
patient,  I  limited  her  to  Hard's  farinaceous  food  with  milk  or  with- 
out, for  breakfast  and  supper,  and  common  milk-and-flour  pudding 
for  dinner,  which  was  afterwards  changed  to  any  one  species  of 
animal  food,  without  vegetables.  At  the  same  time  the  ammonio- 
tartrate  of  iron  was  taken  in  doses  of  four  grains  three  times  a  day, 
with  rhubarb  and  morphia.  Under  a  steady  perseverance  in  this 
plan,  my  patient  perfectly  recovered  health  and  spirits. 

Remarks. — In  cases  like  the  present,  accompanied  by  the  pre- 
dominating symptoms  of  pain  and  acidity,  the  attacks  are  exceed- 
ingly liable  to  recur,  unless  the  patient  can  be  persuaded  to  persevere 
in  a  strict  dietetic  regimen,  and  also  in  medical  treatment.  The 
effects — i.  e.,  pain  and  acidity — are  soon  removed  by  an  appropriate 
plan  of  treatment,  as  is  well  marked  by  the  detail  of  this  case  from 
the  7th  to  the  16th  of  March,  at  which  time  .my  patient  fancied  herself 
well,  but  the  morbid  irritability  of  the  gastric  nerves  is  not  so  soon 
or  so  easily  cured.  As  long  as  they  are  kept  free  from  impression, 
by  having  the  morbid  secretions  corrected,  or  are  not  irritated  by  an 
over-stimulating  diet,  the  patient  is  tolerably  easy ;  but  the  moment 
one  is  discontinued,  or  the  other  indulged  in,  the  attacks  of  pain 
come  on  with  as  much  violence  as  at  first.  This  case  well  illus- 
trates the  evil  of  a  mixed  diet,  in  cases  of  morbid  irritability  like  the 
present,  evidenced  in  the  reports  of  the  patient's  state  on  March  29th 
and  April  18th.  Persons  will  remain  tolerably  easy  under  any  one 
article  of  food,  even  if  it  be  rather  of  a  stimulating  kind  ;  but  a 
mixture  invariably  produces  a  return  of  suffering.  We  know,  from 
the  researches  of  Prout,  Tiedemann  and  Gmelin,  and  Dr.  Beaumont, 
that  the  gastric  juice,  during  digestion,  contains  free  acetic  and 
hydro-chloric  acids,  and  that  these  acids  are  furnished  in  greater 
quantity  in  direct  proportion  to  the  more  or  less  stimulating  quali- 
ties of  the  food:  under  a  mild  farinaceous  diet,  the  acid  is  hardly 
to  be  detected.  It  is  the  impression  of  stimulating  food  upon  a 
morbidly  sensitive  surface  which  gives  rise  to  the  formation  of  so 
great  a  quantity  of  acid,  which,  when  formed,  reacts  upon  the 
mucous  coat,  and  produces  pain.  We  have  certainly  cases  of  dis- 
ease in  which  the  stomach  experiences  pain  merely  from  the  im- 
pression of  food;  but  the  one  under  consideration  appears  to  derive 
additional  Tnischief  from  the  presence  of  its  own  morbid  secretions, 
for  the  moment  they  are  corrected,  and  the  acid  neutralised,  the 
patient  is,  for  the  time,  free  from  pain.  The  plan  of  treatment  con- 
sists in  removing  all  the  sources  of  irritation,  in  correcting  the 
morbid  secretions,  and  rendering  the  nerves  less  sensible  to  impres- 


44  PARKER    ON    THE    STOMACH. 

sion.  The  two  former  objects  are  to  be  accomplished  by  diet  and 
medical  treatment,  such  as  I  have  recommended  in  the  detail  of  the 
case.  For  the  latter  purpose1  I  have  tried  nothing  more  efficacious 
than  the  combination  of  morphia  with  the  salts  of  iron,  at  the  same 
time  having  occasional  recourse  to  the  alkalies.  The  farinaceous 
food,  made  with  milk  and  lime  water  into  gruel  or  puddings,  is 
exceedingly  serviceable.  The  bowels  which  are  inclined  to  con- 
stipation in  most  cases,  may  be  regulated  by  small  doses  of  the 
ponderous  carbonate  of  magnesia  in  some  bitter  infusion,  as  casca- 
rilla  or  orange  peel,  to  which  still  should  be  added  some  sedative, 
of  which  the  liquor  opii  sedativus  is  the  best ;  the  tincture  of  hop 
or  hyoscyamus  may  likewise  be  employed,  but,  as  far  as  my  expe- 
rience goes,  the  first  is  the  best. 

The  sympathetic  affections  of  other  organs  whether  functional  or 
organic,  which  are  called  into  action  by  diseases  of  the  stomach  are 
exceedingly  variable,  and  are  most  commonly  seated  in  the  lungs, 
the  heart,  the  kidneys,  or  the  brain.  Functional  affection  of  the 
brain,  as  regards  the  exercise  of  the  intellectual  faculties,  producing 
despondency,  impaired  judgment,  and  mental  excitement,  is  a  dis- 
ease well  known  as  a  result  of  these,  under  the  term  hypochondria. 
Accompanying  functional  affection  of  the  brain,  as  far  as  that  part 
of  it  devoted  to  the  intellectual  faculties  is  concerned,  we  find  a 
similar  species  of  derangement  extending  to  the  nerves  of  the 
special  senses,  producing  false  impressions  both  upon  the  eye  and 
ear.  The  nerves  here  partake  of  the  same  morbid  action  as  those 
of  the  stomach,  and  convey  false  impressions  to  the  brain  ;  and,  in 
the  second  instance,  this  organ  does  not  receive  the  impressions 
which  are  transmitted  to  it  correctly,  but  judges  of  them  in  an 
erroneous  manner.  The  point  of  commencement  of  this  general 
state  of  nervous  excitement  will,  I  believe,  be  most  commonly 
found  in  the  stomach ;  at  least,  in  the  present  instance,  I  have  only 
to  do  with  it  as  far  as  this  organ  is  concerned  ;  we  shall  find  it  ag- 
gravated or  allayed  in  proportion  to  the  mitigation  or  increase  of  the 
stomach  disease.  It  may  or  may  not  be  accompanied  by  vascular 
excitement. 

CASE  5. — Morbid  sensibility — Epigastric  pulsation,  with  great   mental 

uneasiness. 

A  lady,  aged  forty,  had  menstruated  irregularly  since  the  birth 
of  her  last  child,  which  is  three  years  old  ;  occasionally  profuse  dis- 
charges have  taken  place,  but  iibr  a  month  preceding  her  attack 
there  had  been  none.  Her  food  now  occasioned  great  pain,  accom- 
panied by  nausea  and  great  distension  after  eating.  Sensation  of 
rolling  in. the  stomach,  with  broiling  and  intense  acidity.  These 
symptoms  were  partially  alleviated  by  small  doses  of  the  ponderous 
carbonate  of  magnesia  and  the  application  of  a  blister.  Great 
despondency  succeeded,  with  indescribable  sensations  of  uneasiness 
in  the  stomach,  not  amounting  to  pain,  but  occasioned  by  a  sensa- 


DERANGEMENTS  OF  ITS  SENSIBILITY.  45 

lion  of  rolling  in  it.  The  nausea  continued,  and  frequently  ended 
in  vomiting.  The  tongue  was  clean;  bowels  slightly  constipated; 
pulse  sharp,  and  at  eighty.  On  examining  the  epigastrium,  a  strong 
pulsation  was  evident  to  the  eye ;  it  was  confined  to  this  region, 
and  raised  the  hand  with  great  force  when  laid  over  it ;  it  was  ac- 
companied by  a  dull  pain,  extending  over  a  small  surface,  which 
was  slightly  increased  by  hard  pressure.  The  skin  was  also  here 
very  hot.  Various  remedies  were  tried,  hut  all,  even  the  most 
simple — such  as  the  carbonate  of  soda  or  magnesia,  with  morphia — 
increased  the  pain  and  added  to  the  distress.  Leeches  were  now 
had  recourse  to,  which  were  applied  every  other  day  for  six  days, 
and  were  succeeded  by  one  or  two  blisters.  Under  thifc  treatment 
the  more  urgent  symptoms  yielded,  but  the  uneasiness  of  mind, 
pyrosis,  and  occasional  vomiting,  continued;  which,  when  the 
stomach  was  able  to  bear  medicine,  were  relieved  materially  by 
small  doses  of  morphia  and  lime  water.  During  the  whole  of  this 
distressing  affection,  which  continued  for  several  weeks,  the  patient 
had  the  most  haggard  and  anxious  countenance.  All  kinds  of  ali- 
ment increased  "the  complaint,  except  Hard's  farinaceous  food, 
which  was  taken  with  tolerable  comfort. 

This  case,  similar,  in  many  of  its  features,  to  inflammation  of  the 
mucous  coat  of  a  subacute  character,  does  not  appear  to  me  to  have 
been  a  disease  of  that  nature.  The  extreme  despondency,  almost 
approaching  to  the  insane  state,  the  epigastric  pulsation,  the  almost 
entire  .absence  of  tenderness  on  pressure,  arid  the  more  than  usually 
irritable  state  of  the  stomach  (exceeding  that  observed  in  subacute 
inflammatory  disease),  are,  in  my  opinion,  proofs  that  the  disease 
was  riot  of  this  character  ;  at  least  it  had  other  complications.  The 
"  rolling  sensation,  over  and  over,"  which  this  patient  complained 
of,  is  likewise  peculiar ;  I  have  seen  several  instances  of  it.  The 
heat  in  the  epigastrium  is  worthy,  also,  of  remark.  We  have  in 
this  a  class  of  symptoms  certainly  indicating  increased  local  determi- 
nation of  blood,  but  whether  accompanied  by  inflammatory  action 
of  the  mucous  coat  or  not  is  a  matter  difficult  to  determine  :  I  cer- 
tainly am  inclined  to  think  that  they  are  not.  Dr.  Abercromby 
mentions  the  case  of  a  lady  who  had  constant  vomiting  of  food  and 
severe  pain,  which  at  length  became  so  bad  that  she  was  unable  to 
retain  any  thing  upon  her  stomach,  except  fluids  in  very  small 
quantities.  No  treatment  afforded  relief,  except  blisters  to  the  epi- 
gastrium. She  gradually  wasted  and  died,  and  on  examination  no 
disease  could  be  discovered  in  the  epigastric  region,  except  some 
enlarged  glands  behind  the  stomach.  I  do  believe  that  many  cases 
of  the  description  I  have  related  are  rather  affections  of  the  coeliac 
ganglia  and  great  nervous  centres,1  such  as  the  solar  plexus, 
than  diseases  of  the  coats  of  the  stomach  itself.  The  nature  of  the 
diseases  is  such,  however,  that  this  can  rarely  be  verified  by  dis- 

1  Cerebrum  abdominale,  Lobstein,  Ue  Neivi  Sympathetic!  Fabric^,  Usu  ei 
Morbis,  Commentatio,  &c.,  &c. 


46  PARKER  ON  THE  STOMACH. 

section.  Dr.  Abercromby's  appears  to  verify  this  view  ;  the  direct 
communication  of  the  coronary  plexuses  of  the  stomach  with  the 
great  nervous  centres  of  the  epigastrium  would  at  once  account  for 
any  sympathetic  disease  of  this  organ.  The  distribution  of  the 
nervous  plexuses,  also,  in  the  course  and  upon  the  coats  of  the 
aorta,  and  arterial  branches  in  the  epigastrium,  seem  to  explain  their 
increased  pulsations  by  some  irritation  of  the  nerves  supplying  them. 
We  know  that  in  common  gastritis  epigastric  pulsation  is  rarely 
present.  The  ganglia  and  plexuses  of  the  nerves  of  the  involun- 
tary functions  are  abundantly  supplied  with  arteries,  and  conse- 
quently, must  be  subject  to  the  same  class  of  diseases  as  all  other 
parts  into  wjiich  arterial  blood  penetrates,  particularly  inflammation 
and  its  terminations.  All  the  cases  of  pulsation  in  the  epigastrium 
detailed  in  'this  chapter  were  evidently  owing  to  local  determination, 
and  relieved  by  antiphlogistic  remedies. 

CASE  6. — Morbid  sensibility  of  the  stomach,  with  epigastric  pulsation. 

A  lady  labouring  under  hepatic  disease  became  affected,  during 
its  progress,  with  pain  after  taking  food,  occasional  vomiting,  and 
tenderness  in  the  epigastrium  of  a  slight  character.  There  was  a 
strong  pulsation  at  all  times  visible  to  the  eye,  and  communicating 
a  powerful  impulse  to  the  hand  laid  upon  it.  Her  dyspeptic  symp- 
toms and  the  pulsation  disappeared  after  one  or  two  applications  of 
leeches,  succeeded  by  blisters. 

CASE  7. — Morbid  sensibility  with  great  mental  distress,  succeeding  fever. 

A  lady,  after  an  attack  of  typhous  fever,  became  affected,  during 
her  period  of  convalescence,  with  constant  pain  after  taking  food, 
and  occasional  vomiting;  the  stomach  at  length  became  so  irritable 
that  it  would  not  retain  either  food  or  medicine.  The  mental  un- 
easiness accompanying  this  state  was  distressing  in  the  extreme. 
She  rolled  from  one  side  of  the  bed  to  the  other,  constantly  com- 
plaining of  her  stomach,  and  this  state  continued,  night  and  day, 
for  weeks.  The  tongue  was  clean,  the  pulse  quiet,  the  skin  cool, 
arid  there  was  no  pain  whatever  in  the  epigastrium  when  it  was 
examined  by  pressure.  Opiates,  alkalies,  and  tonics,  all  aggravated 
her  state  of  distress  and  increased  the  uneasiness.  I  once  ventured 
to  administer  a  few  grains  of  the  carbonate  of  iron,  but  its  effects 
were  frightful,  and  the  accession  of  burning  pain  after  it  intolerable. 
Medicines  were  at  length  omitted  altogether,  the  patient  was  removed 
into  the  country,  and  the  mildest  food  given  in  very  small  quantity, 
from  time  to  time.  Under  this  plan,  after  a  long  period,  she  at 
length  recovered. 


DERANGEMENTS  OF  ITS  SENSIBILITY.  47 


CASE  8.— Morbid  sensibility,  with  great  despondency,  succeeding  fever. 

A  lady,  after  an  attack  of  typhous  fever,  which  had  prostrated  her 
whole  family,  and  from  which  she  had  lost  a  favourite  child,  became 
affected  with  pain  after  taking  food,  accompanied  by  a  burning 
sensation,  and  its  occasional  rejection  by  vomiting.  There  was 
extreme  mental  uneasiness  and  great  despondency.  The  tongue 
was  clean  and  moist,  the  pulse  soft  and  quiet,  and  there  was  no 
epigastric  tenderness.  Medicines  and  food  of  all  kinds  aggravated 
her  condition  and  increased  her  distress.  The  former  were  laid 
aside,  small  portions  of  farinaceous  food  were  given  from  time  to 
time,  and  blisters  applied  over  the  stomach.  This  disease  con- 
tinued a  long  time,  but  the  patient,  under  a  continuance  of 
the  farinaceous  diet  and  blisters — the  only  plan  which  afforded 
any  relief — at  length  was  restored  to  her  accustomed  health. 

Cases  five,  seven,  and  eight,  are  examples  of  that  extraordinary 
state  of  mental  wretchedness  dependent  upon  morbid  irritability  of 
the  stomach.  Case  five  differs  from  seven  and  eight  in  being 
accompanied  by  considerable  local  vascular  excitement,  whilst  in 
the  two  latter  it  was  entirely  absent.  The  first  case  succeeding  to 
profuse  uterine  discharges,  whilst  the  latter  are  set  up  during  con- 
valescence from  acute  diseases.  Broussais  and  the  pupils  of  his 
school  attribute,  as  is  well  known,  all  these  affections  to  chronic  or 
snbacute  forms  of  gastro-enteritic  inflammation  ;  his  opinions  on 
this  head  are  detailed  in  his  one  hundred  and  forty-fifth  aphorism.1 
Although  the  brain  becomes  secondarily  affected  from  the  irrita- 
bility of  the  stomach,  it  appears  that  there  must  be  some  peculiar 
organisation  on  the  part  of  the  former,  some  unusual  degree  of  irri- 
tability, which  renders  it  so  liable  to  be  thrown  into  a  state  of  mor- 
bid sympathy  with  diseases  in  other  organs.  That  these  forms  of 
stomach  disease  are  dependent  universally  upon  inflammatory 
action,  I  conceive  to  be  a  highly  dangerous  opinion  to  entertain.  I 
have  seen  patients  leeched  again  and  again,  without  the  least  bene- 
fit, in  such  states.  I  do  not  mean  to  deny  that  increased  local  vas- 
cular action  is  not  occasionally  present ;  I  believe  it  is,  and  was  so 
in  case  five  but  not  in  seven  and  eight.  Where  this  is  present  with 
great  mental  uneasiness,  in  such  states  as  those  described,  it  will 
generally  be  accompanied  by  epigastric  pulsation.  The  great  point 
in  the  treatment  of  these  affections  is  to  remove  all  sources  of  irri- 
tation from  the  stomach,  both  in  the  form  of  food  and  medicine. 
The  smallest  portions  of  the  former  should  at  first  be  tried,  and 
gradually  increased  :  a  table-spoonful  of  gruel,  or  of  Hard's  farina- 
ceous food,  made  with  water,  and  not  milk,  which  is  commonly 
rejected  immediately,  in  form  of  curd,  may  be  given  at  longer  or 
shorter  intervals,  as  the  stomach  will  bear  it.  The  best  medicines, 

1  Examen  des  Doctrines  Medicales,  tome  i. 


48 


PARKER  ON  THE  STOMACH. 


if  the  stomach  will  bear  any,  which  it  sometimes  will  not,  are  a  few 
drops  of  the  liq.  opii  sedativus  in  lime  water,  or  a  quarter  or  a  sixth 
of  a  grain  of  the  acetate  of  morphia,  with  a  few  grains  of  carbonate 
of  soda.  With  these  remedies  blisters  should  be  successively 
applied  to  the  epigastrium;  they  should  be  small  and  suffered  to 
heal,  and  then  reapplied.  I  have  seen  much  mischief  occasioned 
by  large  and  irritating  blisters,  but  particularly  by  the  tartar-emetic 
ointment  and  plaster.  These  add  to  the  irritation  ;  and  I  have  seen 
many  instances  in  which  they  were  productive  of  decided  harm. 
On  the  other  hand,  blisters  of  small  size,  frequently  repeated,  are 
the  best  remedies  I  know  of  in  diminishing  the  irritability  of  the 
stomach ;  and  the  moment  this  viscus  begins  to  regain  its  tone  the 
patient's  mind  becomes  more  settled  and  composed.  In  these 
instances,  as  in  that  before  mentioned,  the  extremely  irritable  mind 
and  morbid  state  of  feeling  of  the  patient  should  never  be  lost  sight 
of,  dependent  as  they  are  upon  the  stomach  disease,  arid  aggravated 
by  every  cause  which  increases  it.  Too  much  caution  cannot  be 
employed,  the  diet  cannot  be  too  unstimulating,  or  the  plan  of  medi- 
cation too  unirritating  and  simple.  Cases  five,  seven,  and  eight, 
are,  as  I  have  before  said,  examples  of  mental  affections  depen- 
dent, no  doubt,  upon  some  cerebral  irritation,  which  was  called 
into  action  by  derangement  of  the  sensibility  of  the  nerves  of  the 
stomach  and  its  vicinity.  Broussais  in  the  commentary  to  his  one 
hundred  and  seventh  proposition,1  tells  us  that  the  sensibilities  of 
the  viscera  are  infinitely  variable,  impressions  which  are  not  sen- 
sible, to  one  person,  becoming,  to  another,  stimuli,  which  are  the 
source  of  various  morbid  actions;  but  that  these  impressions  should 
so  act  he  admits  a  peculiar  idiosyncrasy,  to  which  he  gives  the 
name  of  "  nevropathie"  and  which  consists  in  a  peculiar  and  ex- 
cessive irritability  of  the  nervous  system.  The  opinion  appears 
founded  in  truth  and  nature ;  it  is  the  true  nervous  temperament 
at  its  full  development.  What  in  another  person  would  produce 
bodily  pain,  here  is  productive  of  mental  disturbance.  Insanity  is 
a  common  termination  of  prolonged  irritation  in  the  abdominal 
viscera  of  such  patients,  particularly  in  the  stomach.  I  know  two 
instances  in  my  own  practice,  besides  the  one  I  have  mentioned. 

It  is  of  the  greatest  consequence,  as  regards  the  treatment  of  dis- 
eases of  the  stomach,  both  in  their  primary  and  advanced  stages,  to 
ascertain  whether  the  symptoms  they  exhibit  are  dependent  upon 
nervous  or  vascular  irritation,  whether  the  affection  be  unaccom- 
panied by  inflammatory  action,  or  whether  the  nervous  symptoms 
which  are  manifested  during  the  progress  of  the  disease  depend 
upon  inflammation  or  not,  I  believe  that,  in  a  great  majority  of 
instances,  an  increased  fulness  of  blood  in  the  mucous  membrane 
of  the  stomach  is  present,  at  least  during  the  paroxysm  of  the 
attack ;  yet  we  must  be  extremely  cautious  how  we  take  such  an 

1  Comraentaire  des  Propositions  de  Pathologic,  tome  i.,  p.  117.  Paris, 
1829. 


DERANGEMENT  OF  ITS  SENSIBILITY. 


49 


opinion  as  the  sole  basis  of  our  treatment.  The  degree  of  nervous 
irritation  exhibited,  whether  this  consist  in  actual  pain,  in  mental 
despondency  or  irritation,  in  anomalous  feelings  attended  by  various 
exalted  or  diminished  states  of  the  sensibility  must  be  examined  in 
relation  to  the  actual  state  of  vascular  excitement  with  which  they 
are  or  are  not  accompanied,  and  the  treatment  proportioned  accord- 
ingly. The  relative  proportions  which  these  two  states  of  excite- 
ment bear  to  each  other,  and  the  degree  in  which  each  is  developed, 
must  form  the  basis  of  all  rational  treatment,  both  medicinal  and 
dietetic.  Occasionally  the  symptoms  dependent  upon  an  inflamed 
state  of  the  mucous  coat  of  the  bowels  are  confined  almost  entirely 
to  those  which  are  called  nervous — i.  e.,  phenomena  which  are 
attributed  entire'y  to  the  nervous  system  alone — are  those  merely 
which  are  found  as  indicative  of  inflammatory  disease.  I  shall  lake 
the  table  arranged  by  Jolly  for  the  basis  of  the  distinctions  between 
these  two  states,  making  comments  upon  it,  as  I  proceed,  where  I 
think  the  symptoms  of  difference  are  inaccurate  or  not  to  be 
depended  on. 


SYMPTOMS  OF  THE  NERVOUS 

AFFECTIONS  OF  THE 

STOMACH. 

Pain.1 — Acute,  tearing 
Intermittent 
Diminished  by  pressure 
And  by  taking  food 
More    frequently  coming 

on  in  the  morning. 
Tongue. — Sometimes  coated2 
Broad 
Clean 

Appetite. — Morbidly  increased3 
Depraved. 

Wish  for  high-seasoned 
meats  and  alcoholic 
drinks. 


SYMPTOMS    OF  THE    INFLAMMA- 
TORY AFFECTIONS  OF 
THE  STOMACH. 

Pain.1 — Dull,  obscure 

Constant 

Augmented  by  pressure 

And  by  food 

Increasing    towards    the 

evening 
Tongue. — Almost  always  red3 

Contracted 

Thickly  coated 
Appetite. — Wanting3 

Never  depraved 

Aversion  to  both 


1  The  two  characters  of  pain  described  by  Jolly  cannot  be  depended  upon 
as  showing  any  certain  distinction  between  inflammatory  and  nervous  dis- 
ease of  the  stomach,  that  of  the  nervous  kind  is  so  constantly  associated 
with,  produces,  and  succeeds  to,  partial  inflammations  of  the  mucous  coat. 

2 The  state  of  the  tongue  is  infinitely  variable  in  the  different  forms  of 
disease.  The  observations  of  Louis  and  Andral,  and  my  own  cases,  show 
that  it  may  remain  clean  in  aggravated  forms  of  inflammatory  disease,  even 
where  change  of  structure  has  been  produced.  It  may  be  foul,  and  even 
aphlhous,  where  the  gastric  inflammation  is  not  urgent  or  well-marked. 

'Boulimia,  01  morbidly  increased  appetite,  is  a  symptom  commonly  attend- 
ant on  an  inflamed  condition  of  the  mucous  coat  of  the  stomach.  Total  loss 
of  appetiie  may  also  be  present,  and,  again,  this  function  may  remain  unim- 
paired. We  see  how  uncertain  are  all  these  rational  signs  of  disease.  A 
10— b  park  4 


50 


PARKER  ON  THE  STOMACH. 


SYMPTOMS  OF  THE  NERVOUS 

AFFECTIONS  OF  THE 

STOMACH. 

Taste.— Metallic 

Acid 

Vomiting  of  mucous  discharges 
Alternations  of  Heat  and  Cold 

in  the  abdomen 
Thirst. — Not  increased 

Wish    for   drinks    some- 
times hot,  at  others  cold 
Constipation. — Frequent1 
Stools. — Natural 

.  Not  offensive 

Pulsations  in  the  Epigastrium. 
— Intermittent 

Not  synchronous   with 

those  of  the  heart 
No  Fever 

Or  intermittent 
Increase  of  Disease. — Early  in 

the  day 
Urine.— Clear* 

Abundant 

Heat  of  Skin.— Natural 
No  Progressive  Emaciation 
Physiognomy. — Natural 

Temper. — Morose,  fearful,  irri- 
table 

Diagnostic. Sometimes    ob- 
scure 

Prognostic. — Less  dangerous 
Anatomical  Characters. —  Equi- 
vocal,  or  altogether 
wanting. 


SYMPTOMS    OF  THE    INFLAMMA- 
TORY AFFECTION8  OF 
THE  STOMACH. 

Taste.— Bitter 
Clammy 

Vomiting  of  food 
Constant  Heat 

Thirst. — Increased 

Constant  desire  for  cold 

drinks 

Diarrhoea. — Frequent1 
Evacuations. — Bilious,  mucous, 
or  bloody 

Offensive 

Pulsations  in  the  Epigastrium. 
— Natural,  continual 

Synchronous    with    the 

heart 

Fever. — Frequent 
Continued 
Increase    of  Disease. — In    the 

evening 
Urine. — High  coloured2 

Scanty 

Heat  of  Skin. — Augmented 
Progressive  Emaciation. 
Face. — Pale,  sallow,  or  sunk  and 

anxious 
Temper. — Little  altered 

Diagnostic. — More  manifest 

Prognostic. — More  dangerous 
Anatomical    Characters. — Con- 
stant, but  varied. 


remarkable  case  of  morbidly  increased  appetite,  attendant  upon  cancer  of 
the  stomach,  is  detailed  in  the  Lancet  of  October  1,  1836. 

'Constipation  is  a  symptom  almost  invariably  accompanying  both  forms 
of  disease.  DiarrhoBa  is  certainly  present  in  some  instances  of  the  inflam- 
matory affections,  even  in  the  commencement  of  disease;  in  the  advanced 
stages,  where  complaint  has  extended  to  the  bowels,  it  is  of  more  frequent 
occurrence. 

1  Dezeimeris  has  related  some  cases  where  diabetes  appeared  dependent 
upon  chronic  gastritis,  at  least  the  cure  of  the  gastritis  completely  removed  the 
diabetes.  Andral  has  also  detailed  a  case  where  diabetes  coincided  with 
chronic  gastritis ;  the  former  disease  was  removed  by  curing  the  latter. — 
Clinique  Medicale,  by  Spillan,  p.  869. 


DERANGEMENT  OF  ITS  SENSIBILITY. 


51 


The  symptoms  of  vascular  and  nervous  irritation  of  the  stomach 
are  sometimes  so  similar  that  the  most  experienced  practitioner  in 
diseases  of  this  kind  is  occasionally  at  a  loss  to  decide  upon  their 
precise  pathologic  character.  I  attended  a  patient,  for  two  years, 
with  all  the  symptoms  of  chronic  gastritis,  which  were  accompanied 
by  progressive  emaciation  ;  the  peculiarity  of  the  lancinating  pains 
which  Were  occasionally  felt  in  the  epigastrium,  and  the  clean  state 
of  the  tongue,  made  me  suspect  some  cancerous  affection  of  the 
stomach.  The  extreme  restlessness  of  his  nights  led  to  the  admi- 
nistration of  opiates  in  the  evening,  after  the  disease  had  continued 
for  eighteen  months,  when  he  was  become  much  emaciated.  From 
this  time  the  signs  of  gastric  disease  began  to  decline,  and  at  the 
end  of  some  months  after,  having  continued  the  opiates  for  the 
whole  time,  the  patient  had  gained  much  strength,  and  was  actually 
become  fat.  This,  then,  was  evidently  a  disease  of  sensibility,  pre- 
senting all  the  symptoms  of  a  chronic  inflammatory  state.  Two 
very  remarkable  cases  in  the  Clinique  Medicale,  at  pages  871 
and  876  of  Spillan's  edition,  are  likewise  examples  of  diseases 
of  a  nervous  character  assuming  the  type  of  inflammatory  affec- 
tions in  the  chronic  form.  These  nervous  affections  may  con- 
sist sometimes  in  excitement  (erethism),  at  others  in  diminished 
tone  (atony),  of  the  nervous  influence  of  the  stomach.  They  re- 
semble, however,  sometimes  so  closely  the  inflammatory  affections, 
that  the  results  of  treatment  are  occasionally  our  only  guides  as  to 
their  nature.  "Let  us  not  be  astonished  if,  in  a  considerable 
number  of  patients,  we  see  symptoms  more  or  less  similar  to  those 
which  characterise  chronic  gastritis  become  permanent,  and  even 
aggravated,  by  a  pure  antiphlogistic  treatment,  and  yield,  on  the 
contrary,  to  medicines  of  another  description.  It  is  because  those 
symptoms  were  riot  produced  by  gastritis,  but  by  other  morbid 
states  of  the  stomach/'1  There  is  another  form  of  disease,  to 
which  Barras  has  given  the  name  of  "complication  de  la  gastro- 
enteralgie  avec  la  gastro-enterite,"  in  which  there  is. a  constant 
blending  of  the  symptoms  noticed  in  the  preceding  table.  Thus, 
we  have  the  symptoms  of  gastritis  presenting  themselves,  sometimes, 
with  an  exaltation  of  the  nervous  sensibility  of  the  stomach.  These 
symptoms  of  a  morbid  state  of  the  sensibility  of  the  stomach  may 
be  combined  with  inflammatory  disease  during  it  progress,  render- 
ing the  diagnosis  difficult  and  the  treatment  embarrassing.  They 
may  precede  the  inflammatory  symptoms;  these  may  become  added 
to  the  nervous  after  the  continuance  of  the  disease,  in  this  form,  for 
some  time;  or,  in  the  last  place,  the  gastritis  makes  its  appearance, 
and  derangements  of  the  sensibility  subsequently  come  on. 

'Andraljp.  873. 


52  PARKER  ON  THE  STOMACH. 


CHAPTER  VI. 

ON    AFFECTIONS    OF    THE    STOMACH    CHARACTERISED  BY  MORBID 
STATES  OF  ITS  SECRETIONS. 

I  have  described,  in  the  preceding  chapters,  two  primitive  morbid 
stales  of  the  stomach  ;  the  first  of^an  inflammatory  character,  and 
a  second  which  is  chiefly  characterised  by  a  morbid  condition  of 
its  sensibility.  There  is,  however,  a  third  form  of  primitive  morbid 
state  of  the  stomach,  resembling",  in  some  measure,  in  its  symp- 
toms, the  other  two,  but  differing  from  them  in  its  pathologic  cha- 
racter, and  aggravated  by  either  of  the  modes  of  treatment  appro- 
priate to  the  two  first  forms  of  disease.  This  disease  has  attracted 
the  attention  of  various  writers.  Mr.  Abernethy  has  termed  it  a 
disordered  state  of  the  digestive  organs  or  of  the  chylopoietic  vis- 
cera, and  he  opposed  to  it  mercurial  purges,  with  solutions  of  neu- 
tral salts  in  some  bitter  infusions.  The  late  Dr.  Hamilton,  of 
Edinburgh,  in  his  work  on  Purgative  Medicines,  recognises  the 
morbid  state  of  which  I  am  about  to  speak.  This  kind  of  primitive 
morbid  state  of  the  stomach  consists  in  a  disordered  state  of  secre- 
tions poured  out  by  the  mucous  surfaces  of  the  stomach  and  first 
passages,  or  by  those  glands  whose  products  are  necessary  to  the 
completion  of  the  digestive  process,  of  which  the  liver  is  the  chief. 
The  pathologists  and  physicians  of  the  continent  have  recognised 
this  state  of  the  stomach.  Stoll,  in  his  Ratio  Medendi  and  other 
works,  has  given  numerous  examples  of  it ;  Tissot,  Finke,  De 
Larrroque,  and  Andral,  have  also  described  and  admitted  it  as  a 
state  of  disease  distinct  from  inflammation  and  not  dependent  upon 
it,  although  in  many  instances  associated  with  it.  Broussais  and 
the  pupils  of  his  school  deny  its  existence,  except  as  a  secondary 
affection,  the  consequence  of  inflammation.  Every-day  experience, 
however,  must  convince  those  who  have  paid  attention  to  the  sub- 
ject that  there  is  a  form  of  irritation  in  the  stomach — which  may 
be  taken  as  the  type  of  a  certain  number  of  cases  of  indigestion — 
which  is  not  relieved  by  leeches  to  the  epigastrium,  although  epi- 
gastric pain  and  tenderness  be  present,  nor  is  it  mitigated  by  seda- 
tives or  tonics,  but  gives  way  to  aperients,  and  occasionally  is  only 
cured  by  emetics.  This  disease,  then,  recognises  for  its  cause  a 
morbid  condition  of  the  secretions  of  the  stomach  and  the  liver, 
which,  in  this  condition,  acting  upon  the  peculiar  sensibility  of  the 
mucous  surfaces  of  the  stomach,  produce  various  forms  of  disease 
more  or  less  acute,  either  in  this  organ  itself  or,  by  sympathetic 
irritations,  in  other  parts,  more  particularly  the  brain,  lungs,  and 
heart. 

To  this  form  of  gastric  irritation  some  of  the  French  pathologists 
apply  the  term  "embarras  gastrique,"  whilst  by  others,  as  the 
Broussaists,  this  term  is  applied  to  a  state  of  disease  which  they 
consider  the  first  form  of  inflammation ;  by  others  this  is  termed  a 


MORBID  STATES  OP  ITS  SECRETIONS. 


53 


sabtirral  state  of  the  stomach,  because  the  persons  employing  this 
term  fancy  the  stomach  or  first  passages  to  be  loaded  by  a  mass  of 
morbid  secretions  which  are  termed  saburrae.  In  this  country  the 
comprehensive  term  indigestion  is  applied  indiscriminately  to  this 
as  well  as  the  other  morbid  states  of  the  stomach  which  I  have 
already  mentioned.1 

In  this  affection,  as  I  have  before  said,  a  morbid  condition  of  the 
secretions  is  the  predominant  feature  of  the  disease.  Professor 
Recamier2  has  detailed  accounts  of  the  dissection  of  several  subjects 
who  have  sunk  from  aggravated  diseases  of  this  character.  He 
found,  in  these  cases,  the  liver  pale  and  voluminous,  the  gall-bladder 
full  of  black  bile,  which  was  extravasated  in  large  quantities  in  the 
duodenum,  jejunum,  and  ileum;  the  stomach  and  duodenum  were 
likewise  coated  with  thick  viscid  secretions,  under  which  the 
mucous  membrane  did  riot  present  the  least  trace  of  inflammation 
or  congestion.  Andral  has  also  described  a  disease  under  the  name 
of  gastrorrhosa,  in  which  he  considers  this  state  of  the  secretions,  as 
a  predominant  and  primitive  feature  of  disease,  to  be  as  well  esta- 
blished as  any  other  point  of  pathology. 

In  enquiring  into  the  symptoms  which  denote  or  accompany  these 
forms  of  secretory  irritation,  we  shall  find  them,  in  some  measure, 
resembling  those  of  hypcrsemia,  or  active  congestion  of  the  mucous 
membrane,  or  some  forms  of  inflammation.  They  are  of  two 
classes,  referable,  in  the  first  instance,  to  the  stomach  itself,  and 
secondly,  exhibited  in  various  sympathetic  affections  of  other 
organs. 

In  secretory  irritation  of  the  stomach,  the  two  first  points  that 
demand  our  attention  are  the  state  of  the  tongue,  and  that  of  the 
epigastric  and  hypochondriac  regions.  The  tongue  is  generally 
broad,  rather  pale  and  moist,  not  contracted,  and  without  increased 
redness  at  its  point  or  edges.  The  papillae  are  not  elevated, 
enlarged,  nor  very  vivid  in  their  appearance ;  the  coating  of  the 
tongue  is  thick,  and  of  a  dirty  white  or  yellowish  colour.  The 
epigastric  region  is  full,  but  indolent ;  hardly  sensible  or  tender  on 
pressure,  unless  the  disease  be  of  long  standing.  If  the  complaint 
have  been  long  in  existence  it  occasionally  produces  or  becomes 
associated  with,  increased  vascularity  of  the  mucous  membrane  of 

'11  faut  se  rappeller  que  1'estcmac  secrete  deux  especes  de  liquides:  une 
mucosite  qui  est  produite  par  les  glandes  de  Brunner,  et  une  humeur  acide 
qui  est  proprement  le  sue  gastrique  ;  en  outre.  Porifice  pylorique  est  tel lenient 
dispose  qu'il  n'empeche  pas  le  reflux  de  la  bile  dans  la  cavite  du  ventricule. 
Faut  il  attribuer  a  la  secretion  de,  ces  diflferens  liquides  un  r6le  dans  la  pro- 
duction de  1'ernharras  gastrique  ?  ou  bien  faut  il  n'y  voir  qu'un  certain  degre, 
ou  une  certain  forme  de  1'initation  de  Pestomac? — Littre,  Diction,  de  Mede- 
cine,  2d  edit.,  art.  Gastrique  (fievre  et  embarras).  It  is  plain  that  the  word 
irritation  here  used  is  not  to  be  understood  in  the  sense  generally  applied  to 
it  by  the  French  writers,  that  of  a  certain  degree  of  inflammation,  since,  in 
the  forms  of  disease  of  which  we  are  speaking,  an  antiphlogistic  treatment 
is  commonly  totally  inefficacious,  and  sometimes  positively  hurtful. 

2  Quoted  in  De  Larroque,  Op.  cit.,  p.  307. 


54  PARKER  ON  THE  STOMACH. 

the  stomach ;  and  in  such  instances  the  epigastrium  and  hypochon- 
dria acquire  increased  heat,  and  become  more  sensible  and  tender 
on  pressure.  Both  De  Larroque  and  Andral  have  noticed  this 
complication  of  inflammation,  or  active  congestion,  with  various 
forms  of  disorder  of  the  secretions  of  the  stomach  and  first  passages. 
"  On  opening  bodies,"  writes  the  latter  of  these  authors,  "one  is 
sometimes  struck  with  the  prodigious  quantity  of  mucus  on  the  in- 
ternal su  rface  of  the  stomach  and  intestines.  This  often  forms  a  thick 
layer  extending  over  a  great  portion  of  the  intestine,  which,  at  first 
sight,  might  be  taken  for  the  mucous  membrane  itself,  and  that,  too, 
white  and  healthy.  Beneath  this  layer  of  mucus  the  internal 
surface  of  the  canal  may  appear  in  two  opposite  states.  In  the  first 
place  the  mucous  membrane  may  be  of  a  bright-red  colour,  and  this 
is  even  the  most  usual  case ;  but  it  may  also  be  pale  and  without 
the  least  trace  of  injection,  the  increase  of  a  secretion  not  necessarily 
inferring  the  formation  of  a  sanguineous  congestion  in  the  secreting 
organ.  The  mucous  membrane  that  lines  the  superior  surface  of 
the  tongue  presents,  in  this  respect,  the  greatest  analogy  with  what 
is  found,  on  opening  the  body,  in  that  part  of  the  alimentary  canal 
that  is  concealed  from  view  during  life.  Thus  at  the  same  time 
that  it  is  loaded  with  an  unusual  quantity  of  mucus,  it  is  itself 
sometimes  of  a  bright-red,  sometimes  of  its  natural  colour,  and, 
lastly,  at  times  even  paler  than  natural."1 

When  the  secretory  irritation  becomes  combined  with  active 
congestion  or  inflammation,  there  is  generally  a  change  in  the 
symptoms  which  indicate  it.  Thus,  the  tongue,  which  was  ori- 
ginally pale,  broad,  moist,  and  coated,  becomes  contracted,  red  at 
its  point  and  ed^es,  the  papillae  vivid  and  enlarged.  At  the  same 
time  various  other  symptoms  indicative  of  gastric  hyperemia,  or 
inflammation  are  ushered  in;  to  enumerate  these  would  be  to  re- 
capitulate what  has  been  said  on  this  subject  in  chapter  the  third, 
to  which  I  refer  the  reader. 

As  a  disordered  condition  of  the  secretions  of  the  stomach  may  be 
combined  with  congestion  or  inflammation,  in  some  instances,  so 
may  it  in  others  be  associated  with  a  variety  Of  nervous  symptoms 
which  are  totally  different  from  those  indicating  inci eased  deter- 
mination of  blood,  either  to  the  stomach  or  parts  sympathetically 
affected.  Thus,  many  cases  of  stomach  disease  occasionally  pre- 
sent themselves  where  nausea  and  occasional  vomiting  are.  present, 
bad  taste  in  the  mouth,  with  uneasiness  and  weight  in  the  epigas- 
trium. Sometimes  the  patients  vomit  daily,  and  are  never  free 
from  sickness,  except  for  a  short  time  after  the  stomach  has  dis- 
charged its  food,  or  a  considerable  quantity  of  bile  or  mucus. 
There  is  extreme  mental  despondency  or  irritability,  stupor  and 
weight  in  the  head,  with  severe  pain  over  the  forehead,  quickened 
breathing,  and  a  dry  cough.  Occasionally  diarrhoea  accompanies 

1  A  Treatise  on  Pathological  Anatomy,  translated  by  Drs.  Townsendand 
West.  Tome  i.,  p.  170.  Dublin,  1831. 


MORBID  STATES  OF  ITS  SECRETIONS.  55 

these  states,  or  there  is  an  alternation  of  constipation  and  looseness. 
That  these  symptoms  arise  from  the  presence  of  an  increased 
quantity  or  morbid  quality  of  the  secretions  of  the  stomach,  acting 
upon  the  peculiar  sensibility  of  its  lining  membrane,  is  evident  from 
many  reasons.  The  stomach  affection  and  its  sympathetic  diseases 
are  not  relieved  in  these  states  either  by  bleeding,  counter-irritation, 
opiates,  or  even,  in  many  instances,  by  aperients,  though  these 
are  generally  very  serviceable.  I  shall  detail  some  cases  in  illus- 
tration. 

CASE  1. — A  lady,  aged  twenty-nine,  one  year  married,  had 
suffered  for  three  months  prior  to  her  consulting  me  from  total  loss 
of  appetite,  weight  and  uneasiness  in  the  epigastrium,  constant 
nausea,  with  frequent  vomiting  of  food,  and  mucous  discharges. 
She  had  constant  headach,  seated  in  the  forehead  and  temples,  and 
a  total  indisposition  to  sleep.  The  breathing  was  quickened,  and 
there  was  a  short,  dry,  frequent  cough.  The  lungs,  on  examination, 
afforded  no  evidence  of  disease.  Leeches,  blisters,  and  counter- 
irritants,  had  been  applied  to  the  epigastrium,  with  the  effect  rather 
of  aggravating  than  relieving  any  of  the  symptoms  of  stomach  dis- 
order. Aperients,  in  various  forms,  had  been  tried  to  their  fullest 
extent;  opiates  had  also  been  administered,  with  a  view  of  pro- 
curing some  rest ;  but  all  had  failed.  The  patient  actually  passed 
night  after  night  without  closing  her  eyes.  Leeches,  were  now 
applied  to  the  temples  and  behind  the  ears,  and  these  were  succeeded 
by  blisters;  these  remedies  aggravated  the  pain  in  the  head,  and 
brought  on  delirium.  The  stomach  still  continued  in  the  same 
state,  in  spite  of  all  that  had  been  done;  whilst  the  sympathetic 
irritation  of  the  head  and  chest  were  worse.  I  now  reflected 
whether  I  had  not  to  treat  one  of  those  diseases  which  depend  upon 
the  accumulation  of  a  mass  of  morbid  secretions  in  the  stomach  and 
first  passages,  and  which,  though  admitted  as  a  fruitful  source  of 
disease  by "Stoll,  Tissot,  Finke,  Porame,  De  Larroque,  and  others, 
had  been  almost  ridiculed  out  of  the  domain  of  pathology  by  the 
doctrine  of  irritation  substituted  by  Broussais,  in  which  all  these 
secretory  disorders  are  considered  as  the  result  of  inflammatory 
action.  Finding  that  local  depletion,  blisters,  counter-irritants,  and 
aperients  had  failed,  whilst  the  state  of  the  patient,  the  heat  of  skin, 
and  arterial  excitement,  completely  prohibited  the  exhibition  of 
tonics,  I  determined  to  try  the  effects  of  the  tartar  emetic,  from 
which  vast  benefit  had  been  derived  in  such  instances,  by  De 
Larroque  andAndral.  Two  grains  of  this  substance  were  adminis- 
tered. The  patient  vomited  an  immense  quantity  of  bilious  and 
mucous  fluids  ;  the  stomach  became  comfortable,  the  sickness  and 
nausea  disappeared,  and  for  two  days  the  head  remained  free  from 
pain.  In  a  few  days  the  symptoms  returned  in  a  milder  form.  The 
remedy  was  again  employed  ;  vomiting  of  the  same  discharges  to  a 
much  less  extent.  After  a  third  repetition  there  was  no  more  return 
of  complaint;  the  patient  became  perfectly  convalescent. 

Remarks. — This  case  exhibits  two  or  three  points  which  it  is 


56  PARKER  ON  THE  STOMACH. 

important  to  notice  : — 1st.  That  secretory  irritations  of  this  kind 
may  continue  for  an  indefinite  period  without  being  accompanied 
with  any  real  inflammatory  action  of  the  stomach.  2d\y.  The 
sympathetic  affections  which  they  excite  are  sometimes  of  a  purely 
nervous  character  and  aggravated  by  all  antiphlogistic  treatment, 
as  the  present  case  shows.  We  need  only  refer  to  the  effects  of 
treatment  to  establish  this.  Occasionally  those  states  of  the  head 
which  succeed  to  such  forms  of  irritation  in  the  stomach,  terminate 
in  stupor,  serous  apoplexy,  or  fatal  forms  of  cerebral  congestion; 
but  effusion  of  serum  is  more  common  than  the  latter  state.  In 
speaking  of  the  diseases  of  the  brain  which  succeed  to  different  forms 
of  gastric  irritation,  we  shall  enter  into  this  more  fully. 

I  shall  now  bring  forward  a  case  to  show  that  these  forms  of 
disease  in  the  stomach  may  assume  a  purely  chronic  form,  and 
sirnilate  confirmed  inflammatory  disease,  yet  consist  entirely  in  a 
disordered  state  of  the  secretions. 

CASE  2. — A  lady,  thirty-seven  years  of  age,  in  consequence  of 
a  series  of  calamities,  became  troubled  with  an  affection  of  the 
stomach,  characterised  by  the  following  symptoms: — Pain  after 
taking  even  the  simpler  kinds  of  food,  which  was  accompanied  by 
a  convulsive  cough  that  continued  till  what  was  taken  had  been 
rejected  by  vomiting ;  the  more  severe  the  pain  which  followed  a 
meal  the  more  troublesome  and  intense  was  the  cough.  She  had 
nausea,  flatulence,  uneasy  feelings  in  the  region  of  the  stomach,  and 
sudden  flushings  of  the  face ;  she  had  no  appetite,  a  broad  coated 
tongue,  offering  no  traces  of  redness  at  its  point  or  edges,  although, 
considerable  pain  existed  in  the  epigastrium  and  in  the  right  hypo- 
chondrium.  There  was  an  alternation  of  constipation  and  diarrhoea, 
the  pulse  a  little  frequent,  the  urine  scanty,  sleep  disturbed,  and  the 
temper  morose  and  irritable.  These  symptoms  had  existed  for  four 
years  with  little  variation,  during  which  time  the  patient  had  ema- 
ciated considerably. 

The  medical  attendants  of  this  lady,  concluding  that  she 
laboured  under  some  obscure  and  chronic  inflammatory  affection 
of  the  stomach,  recommended  the  application  of  fifteen  leeches  to 
the  epigastrium. 

This  local  bleeding  aggravated  all  the  symptoms,  the  pains  con- 
nected with  the  stomach  and  the  process  of  digestion  were  con- 
siderably increased,  the  appetite  rendered  worse,  whilst  the  cough 
became  more  frequent  and  hoarser  than  before  the  application  of 
the  leeches. 

Blisters,  aperients,  and  various  other  remedies  had  been  tried 
without  success,  or  at  least  with  but  temporary  benefit.  M.  De 
Larroque,  under  whose  care  the  patient  was  placed  in  an  advanced 
stage  of  her  disease,  on  closely  analysing  the  symptoms  and  reflect- 
ing on  the  failure  of  the  remedies  previously  employed,  was  led  to 
suppose  that  the  irritation  in  the  stomach  might  be  of  the  secretory 
kind,  and  probably  a  recourse  to  the  use  of  emetics  might  be  of 
service.  Constipation  was  present,  and  the  patient  had  experienced 


MORBID  STATES  OF  ITS  SECRETIONS.  57 

a  partial  relief  of  her  symptoms  from  the  use  of  aperients  ;  but  the 
disease  had  soon  become  as  distressing  as  ever. 

At  this  period  the  patient  was  ordered  twenty-four  grains  of  ipe- 
cacuanha to  be  taken  at  two  doses.  She  threw  up  an  enormous 
quantity  of  bile  and  mucus;  the  cough  diminished  with  all  the 
other  symptoms  ;  a  recourse  was  now  had  to  purgative  medicines, 
which  in  a  few  weeks  completely  restored  the  patient.1 

Remarks. — In  this  case  we  observe  the  disease  to  have  assumed 
a  more  chronic  form  than  in  the  last;  it  had  existed  four  years 
when  placed  under  M.  de  Larroque's  care,  was  accompanied  by 
emaciation,  and  certainly  assumed  all  the  appearance  of  an  organic 
affection  of  the  stomach.  We  witness  here  the  failure  of  bleeding 
and  counter-irritation  over  the  epigastric  region,  as  also  of  pur- 
gative medicines;  with  regard,  however,  to  the  latter,  it  is  most 
probable  that  a  judicious  administration  of  mercurial  aperients,  or 
alteratives  with  warm  stomachics  and  aloetics  might  have  accom- 
plished a  cure,  since  we  see  that  castor  oil,  the  only  remedy  used  as 
an  aperient,  was  productive  of  partial  benefit,  and  after  the  use  of 
the  emetic  was  singularly  useful  in  forwarding  the  cure.  The 
alternation  of  diarrhoea  with  constipation,  in  such  affections  as  the 
present,  does  not  contra-indicate  the  treatment  either  by  purgatives 
or  emetics.  Andral  has  recorded  some  cases  of  the  successful 
treatment  of  bilious  diarrhoeas  by  emetics.2 

In  this  case  we  observe,  also,  a  chronic  affection  of  the  respiratory 
organs  supervene  upon  that  of  the  stomach,  accompanied  by  a  con- 
vulsive cough.  I  have  detailed  in  a  subsequent  part  of  this  work 
many  cases  where  affections  of  the  lungs  have  succeeded  to  those 
of  the  stomach  of  the  inflammatory  kind.  Those  morbid  states  of 
the  stomach,  however,  which  consist  in  a  disordered  state  of  its 
secretions  are  not  less  productive  of  disease  in  the  respiratory 
apparatus. 

These  affections  of  the  organs  of  respiration  may  exhibit  them- 
selves in  various  forms ;  in  acute  pains  in  the  chest,  resembling 
those  of  pleurisy  ;  in  various  morbid  conditions  of  the  respiration, 
which  may  be  hurried  or  irregular  ;  in  cough ;  in  frothy,  mucous, 
or  bloody  expectoration,  to  so  great  an  extent  as  to  lead  to  the 
belief  that  they  are  actually  dependent  on  organic  disease  of  the 
lung. 

CASE  3. — A  mason,  aged  twenty,  resident  in  Paris  for  a  year,  felt, 
during  the  last  fifteen  days,  a  pain  under  the  left  breast ;  it  was 
increased  by  percussion  and  strong  inspiration.  He  had  no  cough 
and  breathed  freely.  For  the  last  ten  or  twelve  days  he  had  some 
purging;  his  tongue  was  covered  with  a  thick  yellowish  coat ;  he 
had  no  fever. 

1  J.  B.  de  Larroque,  op.  cit.,  2me  Section  de  1'etat  saburral  des  premieres 
voies,  &c.,  ch.  1.,  Observation  5me. 

2  Clinique  Medicale,  &c.,  by  Spillan,  p.  709,  Case  60. 


68 


PARKER  ON  THE  STOMACH. 


The  day  after,  the  8th  of  May,  he  took  twelve  grains  of  ipe- 
cacuanha and  a  grain  of  tartar  e'metic.  He  vomited  once  a  great 
quantity  of  bile  and  thick  mucus. 

On  the  9th  the  pain  of  the  side  was  entirely  gone ;  the  tongue 
had  become  clean. 

On  the  10th  the  diarrhoea  had  disappeared.  The  patient  was 
perfectly  restored. 

A  new  circumstance  presented  itself  to  us  in  this  case,  namely, 
the  administration  of  an  emetic  whilst  there  was  diarrhoea,  and  the 
cessation  of  this  diarrhoea. after  the  vomiting. 

This  slight  disease  presents  several  traits  of  resemblance  to  an 
affection  described  by  Stoll  under  the  term  of  "bilious  pleurisy:" 
loss  of  appetite,  bitter  taste  in  the  mouth,  spontaneous  vomiting, 
thick  coating  of  the  tongue,  purging,  and  at  the  same  time  a  fixed 
pain  in  a  point  of  the  thoracic  parietes  ;  lastly  the  rapid  disappear- 
ance of  the  stitch  in  the  side,  and  the  other  symptoms  after  the  em- 
ployment of  an  emetic.1 

CASE  4.— A  widow  aged  fifty-six  years,  who  had  previously 
enjoyed  the  best  health,  gradually  lost  her  appetite.  She  had  a  fre- 
quent disposition  to  vomit,  and  constantly  threw  up  her  food,  mixed 
with  a  considerable  quantity  of  tenacious  ropy  mucus.  The  tongue 
was  coated,  the  mouth  bitter,  the  abdomen  full,  and  slightly  tender 
on  pressure;  the  bowels  were  confined,  the  stools,  when  passed, 
hard  and  dry.  At  the  same  time  she  suffered  from  a  considerable 
difficulty  of  breathing;  the  respirations  were  drawn  with  great 
difficulty,  accompanied  with  a  strong  whistling  noise,  as  in  some 
asthmatic  patients.  She  was  unable  to  lie  down  or  sleep,  and 
passed  the  night  in  her  chair. 

This  patient,  experienced  a  temporary  relief  from  injections,  but 
the  stomach  derangement,  and  that  of  the  respiration,  soon  became 
as  violent  as  before.  She  was  now  recommended  to  take  two  scru- 
ples-of  ipecacuanha  with  one  grain  of  emetic  tartar.  This  pro- 
duced an  enormous  discharge  of  bilio-mucous  fluids:  the  stomach 
was  relieved,  the  breathing  more  free;  she  slept.  Several  relapses, 
though  by  no  means  to  the  primitive  degree  of  complaint,  succeeded. 
These  were  subdued  by  the  alternate  use  of  emetics  and  aperients; 
and  in  a  short  time  the  patient  became  perfectly  convalescent.2 

CASE  5. — A  little  boy,  aged  ten,  previously  in  good  health,  gra- 
dually lost  his  appetite,  and  was  occasionally  sick.  The  tongue 
was  loaded  with  a  thick  fur,  but  offered  no  traces  of  increased  red- 
ness, either  on  the  borders,  the  apex,  or  the  papillae!.  He  complained 
of  pain  in  the  epigastric  region  ;  but  there  was  no  heat  in  this 
situation,  neither  was  it  sensible  to  pressure.  The  bowels 
were  alternately  relaxed  and  confined;  the  stools  were  offensive, 
green,  and  thin.  Some  time  after  the  commencement  of  these 
gastro-intestinal  symptoms,  he  began  to  be  harassed  with  incessant 

1  Clinique  M£dicale,  Spillan's  translation,  Case  59,  p.  708. 
8  Stoll,  Ratio  Medendi. 


MORBID  STATES  OF  ITS  SECRETIONS.  59 

cough,  which  tormented  him  night  and  day.  He  was  hardly  free 
from  it  a  moment;  it  continued  week  after  week.  The  child  ema- 
ciated, and  appeared  to  be  in  the  last  stage  of  an  organic  disease. 
It  was  evident  that  the  cough  was  gastric,  for  the  lungs,  on  the 
most  repeated  and  careful  examination,  afforded  no  evidence  of  any 
morbid  action.  Still,  however,  the  nature  of  the  gastric  affection 
was  misconceived:  it  was  suppposed  to  be  inflammatory.  Leeches 
were  applied  day  after  day;  they  relieved  the  cough,  gastric  symp- 
toms, vomiting,  &c.,  for  a  time,  but  in  a  few  hours  they  returned 
with  increased  intensity.  He  was  now  treated  with  emetics.  Im- 
mense discharges  of  mucus  mixed  with  bile  were  thrown  up;  the 
cough  diminished,  the  sickness  left  him.  The  administration  of  a 
few  mercurial  aperients  completely  restored  the  patient. 

This  case,  very  similar  to  several  related  by  M.  de  Larroque,  is 
very  instructive.  It  shows  us,  as  some  of  the  preceding  ones  do, 
a  disease,  in  many  of  its  features,  resembling  chronic  inflammation 
of  the  stomach;  yet  we  find  it  does  not  yield  to  antiphlogistic  treat- 
ment. We  see  here  the  patient  wasting  with  total  loss  of  appetite 
and  occasional  sickness,  with  pain  in  the  region  of  the  stomach, 
which  assumes  all  the  features  of  an  organic  affection,  yet  quickly 
relieved  by  the  discharge  of  a  quantity  of  bilio-mucous  fluids  from 
the  stomach  and  first  passages.  In  pure  inflammatory  disease  of 
this  organ,  accompanied  by  vomiting,  food  only  is  rejected,  the 
mucous  membrane  of  the  stomach  bein^  dry.  In  the  forms  of  dis- 
ease of  which  we  are  speaking,  the  patient  generally  vomits  quan- 
tities of  bile  and  mucus,  which  for  a  time  relieve  him.  This  is  the 
gastrorrhoea  of  Andral.  itself  one  form  of  secretory  irritation. 

We  notice,  in  the  history  of  this  case,  the  effects  of  bleeding. 
For  a  few  hours  after  the  application  of  leeches  the  symptoms  were 
ameliorated,  but  they  invariably  returned  with  greater  intensity  the 
next  day;  so  that,  in  fact,  the  patient  was  always  rendered  worse 
by  them,  and  they  were  always  more  deleterious,  as  they  were  ac- 
companied by  a  greater  loss  of  blood.  Precisely  the  same  effects 
took  place -in  all  the  patients  treated  in  this  way  by  M.  de  Larroque 
who  were  ultimately  cured  by  emetics  and  aperients.1 

CASE  6. — A  married  lady  consulted  me  for  an  affection  of  the  sto- 
mach which  had  harassed  her  for  some  years,  and  which,  at  its  first 
commencement,  had  been  relieved  by  blue  pill  and  warm  aperients. 
These  remedies  had  now  ceased  to  afford  her  relief,  at  least  it  was 
so  transitory  and  partial  that  it  could  hardly  be  called  relief.  She 
suffered,  at  the  period  of  her  consulting  me,  from  constant  nausea, 
occasional  fits  of  vomiting,  which  discharged  large  quantities  of 
slimy  sour  mucus,  not  food,  and  came  on  chiefly  at  those  periods 
when  the  stomach  was  empty.  There  existed  a  feeling  of  pain 
and  constriction  across  the  epigastrium,  which  was  hot  and  slightly 

1  See  Cases  1,  2,  3,  4,  and  5,  of  the  treatise  of  M.  de  Larroque,  De  quel- 
ques  maladies  abdominales,  &c.,  Sec.  2dj  De  1'etat  saburral  des  premieres 
voies,  &c.  Page  255,  et  suivantes. 


60  PARKER  ON  THE  STOMACH. 

tender  on  pressure;  in  addition  to  these  symptoms,  there  was  a 
teasing  cough  and  some  diarrhoea.  The  tongue  was  not  contracted 
but  coated,  and  inclined  to  redness. 

Believing  that,  in  this  case,  the  disease  was  combined  with,  and 
dependent  upon,  a  state  of  hyperemia,  or  active  congestion,  if  not 
an  inflamed  state  of  the  mucous  coat  of  the  stomach,  ten  leeches 
were  applied  over  the  epigastrium,  and  the  patient  was  recommended 
to  take  the  mist.  creta3  with  hydrocyanic  acid,  with  a  view  of  ab- 
sorbing and  correcting  the  acidity  of  the  secretions.  These  reme- 
dies afforded  considerable  relief,  and  for  a  time  the  patient  was 
tolerably  well.  The  local  depletion  had  entirely  removed  the  epi- 
gastric pain  and  constriction,  the  patient  ceased  to  vomit,  and  was 
no  longer  tormented  with  nausea  or  vomiting  of  mucous  discharges. 
Some  time  afterwards  she  became  a^ain  ill,  with  the  same  symp- 
toms. Leeches  now  afforded  no  relief;  she  was  constantly  sick; 
uneasiness  and  weight  existed  in  the  epigastrium;  the  tongue  was 
not  so  red  as  before,  and  the  symptoms  of  increased  determination 
of  blood  to  the  coats  of  the  stomach  did  not  appear  strongly  marked. 
I  should  mention  that  aperients  now  rather  increased  the  complaint 
than  at  all  relieved  it;  they  brought  on  distressing  loosenes  when 
administered  in  very  small  doses.  I  now  determined  to  administer 
an  emetic,  and  consequently  two  grains  of  the  tartar  emetic  were 
given.  A  large  quantity  of  slimy  mucus,  mixed  with  bile,  was 
vomited;  the  sickness  disappeared,  with  the  weight  in  the  epigas- 
trium, and  diarrhoea;  the  patient  was  restored  to  a  degree  of  health 
she  had  not  for  some  time  enjoyed. 

Remarks. — This  case  is  an  example  of  secretory  irritation  of 
the  stomach  accompanied  by  increased  fulness  of  blood  in  it  mu- 
cous coat,  upon  which,  most  probably,  the  increased  quantity  and 
morbid  state  of  the  secretions  was  dependent.  It  was  evident  from 
the  effects  of  remedies  that,  on  my  first  seeing  this  patient,  such 
was  the  case:  hence  the  success  of  the  treatment.  This  case  pre- 
sents several  symptoms  which  do  not  correspond  with  a  state  of 
ordinary  inflammation — the  character  of  the  discharges  by  vomit- 
ing, and  the  period  of  their  occurrence,  viz.,  when  the  stomach  was 
empty,  and  not  after  a  meal.  Still  we  find  symptoms  which  lead 
us  to  suppose  that  an  undue  fulness  of  blood  in  the  vessels  and 
coats  of  the  stomach  was  present;  such  are  heat,  pain,  and  tender- 
ness in  the  epigastrium.  The  indications  of  treatment  in  such 
forms  of  combination  are,  to  diminish  the  fulness  of  the  vessels  of 
the  stomach,  to  improve  the  qualities  of  its  secretions,  and  to  lessen 
its  irritability.  For  this  purpose  I  know  of  no  plan  of  treatment 
more  efficacious  than  that  detailed  in  the  management  of  this  case, 
in  the  earlier  periods  of  the  disease.  The  existence  of  diarrhoea 
precludes  the  use  of  aperients;  for  I  have  constantly  found,  in  such 
forms  of  disease,  that  they  readily  produce  hypercatharsis,  however 
mild  they  may  be.  The  mist,  cretas  with  hydrocyanic  acid  is  the 
best  remedy  I  know  of  in  such  states;  it  frequently  affords  the 
patient  vast  relief. 


MORBID  STATES  OF  ITS  SECRETIONS.  61 

When  I  last  saw  this  patient  the  secretory  irritation  appeared 
uncombined  with  hyperemia,  and  I  then  ventured  to  use  an  emetic: 
it  was  of  great  service.  These  remedies,  however,  cannot  be  used 
with  too  great  caution ;  since  many  forms  of  inflammation  in  the 
stomach  are  so  insidious  that  they  may  escape  an  upractised  ob- 
server. They  should  only  be  used  when  the  disease  is  most  per- 
fectly uncombined  with  hyperemia  or  inflammation,  and  then  not 
till  all  other  remedies  have  failed;  since  we  find  many  examples  of 
their  exhibition,  in  different  forms  of  irritation  of  the  stomach,  to 
have  produced  fatal  inflammatory  disease.  When  any  form  of  irri- 
tation exists  in  the  stomach,  it  appears  more  prone  to  become 
inflamed  from  the  exhibition  of  stimulants,  either  medicinal  or 
dietetic,  than  if  no  such  irritation  existed.  Hence,  many  diseases 
of  this  organ  purely  nervous  or  atonic  in  their  commencement,  are 
rendered  in  the  sequel  inflammatory. 

I  have  shown  that  secretory  irritation  of  the  stomach  exists  with 
two  totally  opposite  pathological  conditions  of  its  mucous  coat: 
one  in  which  this  membrane  is  of  its  natural  and  healthy  colour, 
or  even  paler  than  natural;  and  a  second  in  which  it  exhibits  marks 
of  active  congestion  or  inflammation.  The  last  case  detailed  was 
of  the  latter  character,  at  least  in  its  commencement.  I  shall  now 
bring  forward  a  case  related  in  the  Dublin  Journal  of  Medical 
Science  for  July,  1837,  which  well  exhibits  the  latter  form  of  dis- 
ease, and  shows  us  how  careful  we  should  be  in  our  examination 
of  the  patient  before  determining  upon  the  plan  of  treatment;  since 
a  disease  evidenced  by  symptoms  closely  resembling  each  other 
may  depend  upon  two  states  of  irritation  in  the  organ  affected,  of 
totally  opposite  characters,  and  requiring  different  modes  of  treat- 
ment. 

CASE  7. —  A  woman,  named  Hutchinson,  was  admitted  into  Sir 
Patrick  Dun's  Hospital  on  the  26th  of  March,  1820,  complaining 
of  headach,  pain  in  the  left  side,  nausea,  and  soreness  of  the  throat. 
These  symptoms  increased,  with  constant  retchings,  waterbrash, 
heartburn,  and  hysterical  paroxysms.  On  the  15th  of  April  food 
only  remained  a  quarter  of  an  hour  on  the  stomach;  an  acid  fluid 
was  discharged  in  quantities  of  a  dark  coffee-ground  colour,  with 
burning  heat  of  the  stomach,  excoriation  of  the  mouth  and  fauces, 
and  obstinate  costiveness.  She  received  no  benefit  from  the  treat- 
ment, which  consisted  in  a  mercurial  course  pushed  to  salivation, 
and  bleeding.  In  fact,  the  remedies  appear  to  have  done  harm: 
the  vomitings  continued:  she  was  pale,  but  not  emaciated.  In 
1823  her  disease  is  thus  described  by  Dr.  Graves:  "The  fits  of 
vomiting  last,  from  ten  to  fourteen  days,  recurring  at  intervals  of 
about  five  weeks;  the  attacks  preceded  and  accompanied  by  acute 
pain,  and  tenderness  in  the  epigastrium.  When  she  swallows,  it  is, 
for  the  most  part,  instantly  rejected,  and  her  sufferings  continue 
day  and  night,  without  intermission.  Quantity  of  fluid  amounting 
to  several  basinfuls  daily  rejected;  so  acrid  as  to  excoriate  throat, 
tongue,  and  fauces:  'with  a  constant  exudation  of  blood  from  the 


62  PARKER  ON  THE  STOMACH. 

whole  inner  surface  of  the  month.  This  fluid  often  contained  a 
large  proportion  of  mucous  flocculi  of  a  dark  colour,  which  im- 
parted to  the  whole  the  appearance  of  being  mixed  with  a  blackish 
colouring  matter."  In  1849  a  seton  was  placed  over  the  stomach, 
which  at  first  gave  vent  to  a  yellowish  fluid,  but  subsequently  to  a 
large  quantity  of  a  fetid  inky  or  dark-blue  fluid.  Whilst  the  seton 
continued  to  discharge  the  vomitings  ceased,  but  on  its  being  dried 
up  they  returned,  and  the  patient  could  not  be  prevailed  upon  to 
have  a  new  drain  opened.  She  was  then  treated  with  repeated 
blisters  over  the  part,  cupping,  leeching,  or  general  bleeding,  with 
injections,  and  calcined  magnesia  in  cinnamon  water:  the  carbonate 
of  magnesia  always  gave  intense  pain  when  substituted.  These 
remedies  acted  well  for  three  years,  and  the  attacks  were  lessened 
to  three  or  four  in  the  year.  Very  small  doses  of  calomel  and 
opium  were  tried  instead  of  magnesia,  which  seemed  to  have  lost 
its  effect;  a  few  grains  caused  salivation  in  two  or  three  days,  and 
the  relief  was  remarkable  and  immediate.  Some  aperient  pills 
and  soda  water  (after  its  effervescence  had  subsided)  then  kept  the 
bowels  free  and  checked  the  vomiting,  which  generally  ceased  or 
lessened  as  soon  as  they  acted  regularly. 

She  died  suddenly,  after  drinking  part  of  a  glass  of  whisky. 
On  examination  after  death  the  mucous  membrane  of  the  stomach 
was  found  intensely  inflamed,  the  cardiac  orifice  especially,  which 
was  of  a  deep  red  colour  ;  pyloric  orifice  quite  sound.  Duodenum 
highly  inflamed,  its  mucous  membrane  red  and  rough.  A  quantity 
of  creamy  mucus  adhered  to  the  mucous  membrane  of  the  duode- 
num and  jejunum,  bloody  effusion  under  the  mucous  membrane  in 
spots,  which  were  of  a  dark  colour;  and  in  some  situations  bloody 
mucus.  Ascending  and  descending  colon  highly  inflamed ;  trans- 
verse arch  not  so  much  so;  bladder  and  rectum  healthy.1 

Remarks. — This  case  presents  some  peculiarities  which  demand 
particular  attention;  they  relate  to  the  duration  of  the  disease,  its 
character,  and  mode  of  treatment.  I  have  shown,  in  that  part  of 
the  subject  of  this  book  which  treats  of  "Affections  of  the  Stomach 
characterised  by  Derangements  of  its  Sensibility,"  that  secretory 
irritations  of  this  kind  will  sometimes  take  place  tinder  the  influence 
of  mere  nervous  irritation;  and  Case  4,  page  41,  affords  a  remark- 
able example  of  this.  In  the  example  before  us,  however,  the 
morbid  state  of  the  secretions  was  evidently  combined  with  inflam- 
mation, at  least  in  the  latter  years  of  disease,  though,  perhaps,  not 
strictly  dependent  upon  it:  I  certainly  think  not.  The  best  plan 
of  treatment  that  could  have  been  adopted  would  have  been  to  have 
given  her  large  quantities  of  chalk  with  morphia  or  hydrocyanic 
acid,  or  the  ponderous  carbonate  of  magnesia  with  the  sub-nitrate 
of  bismuth  and  morphia:  at  the  same  time  to  have  applied  small 

'"Case  of  long-continued  Vomiting,  &c.,  attended  by  some  Remarkable 
Circumstances,"  by  C.  P.  Croker,  M.  B.,  &c.  in  the  Dublin  Journal  ol  Medica  i 
Science  for  July,  1837. 


MORBID  STATES  OF  ITS  SECRETIONS. 


63 


numbers  of  leeches  to  the  epigastric  region ;  to  have  followed  them 
up  by  blisters,  the  surfaces  of  which  should  have  been  dusted  with 
the  muriate  of  morphia.  We  have  not,  in  such  instances,  to  treat 
merely  an  inflammatory  disease,  but,  combined  with  inflammation, 
a  peculiar  morbid  condition  of  the  secretions,  which  as  often  appears 
uncombined  with  inflammation  as  it  does  with  it.  I  am  inclined 
to  suppose  that  the  inflammation  itself  may  be  the  result  of  the 
constant  irritation  kept  up  by  such  acrid  secretions  upon  the  mucous 
coat  of  the  stomach,  containing  as  they  most  commonly  do,  in 
such  instances,  large  quantities  of  free  hydrochloric  and  acetic 
acids.  I  refer  the  reader  for  further  detail  on  this  subject  to  the 
remarks  to  Case  4,  page  41. 

OF  GASTRORRHCEA.1 

A  morbid  condition  of  the  stomach  has  been  described,  under 
this  title,  by  Andral  and  Roche,  which  consists  in  the  secretion  of 
an  excessive  quantity  of  mucus  from  the  lining  membrane  of  the 
stomach.  This  secretion  may  be  merely  increased  in  quantity,  or, 
in  addition  to  this,  it  may  present  various  alterations  in  its  chemical 
compositition. 

Anatomical  characters  of  the  disease. — Andral  thus  describes 
them :  "  On  opening  bodies,  we  commonly  find  a  thick  layer  of 
adhesive  slimy  mucus  exhaled  on  the  surface  of  the  mucous  mem- 
brane of  the  stomach,  whilst  this  membrane  does  not  present  the 
least  traces  of  inflammation.  Thus,  we  find  gastrorrhoea  existing 
apart  from  any  inflammatory  action  ;  but  again,  in  certain  circum- 
stances, it  succeeds  to  it:  and  here  the  mucous  membrane  of  the 
stomach  comes  under  the  influence  of  that  law  in  pathology  in 
virtue  of  which  all  inflammations  of  mucous  membranes,  when 
arrived  at  a  certain  period,  assume  the  character  of  a  simple  flux. 
We  observe  this  in  the  mucous  surfaces  of  the  bronchige,  of  the 
urethra,  arid  of  the  vagina.  In  some  cases,  also,  the  augmentation 
of  the  secretion  of  the  mucous  membrane  of  the  stomach  is  depend- 
ent on,  or  coincides  with,  a  true  inflammation."2 

Gastrorrhoea  may  appear,  however,  in  other  conditions  of  the 
stomach  beside  those  specified  by  Andral ;  and  hence  we  occasion- 
ally find  it  accompanying  purely  nervous  diseases  of  the  stomach, 
as  gastralgfia  and  others.  It  is  then,  as  in  the  instances  in  which 
it  succeeds  to,  or  is  combined  with,  inflammation,  not  a  disease, 
but  a  symptom,  requiring,  it  is  true,  a  particular  mode  of  treatment, 
but  not  one  to  be  adopted  apart  from,  and  without  regard  to,  the 
primitive  affection  with  which  it  is  combined.  It  is  only  to  be 
considered  a  primitive  morbid  state  when  it  exists  without  any 

1 "  Catarrh  Chronique  de  PEstomac,"  Roche.— -Dictionnaire  de  Medecine 
et  de  Chirurgie  Pratique.  "  Flux  Muqueux  de  PEstoraac,"  Andral— 
Cours  de  Pathologic  Interne. 

*  See  Cours  de  Pathologie,  &c.,  p.  84,  et  suivantes. 


64  PARKER  ON  THE  STOMACH. 

appreciable  vascular  or  nervous  irritation,  and  as  such  it  is  com- 
monly met  with. 

Symptoms.—  These  are  to  he  sought  for  in  the  stomach  itself, 
and  in  the  sympathetic  affections  of  other  organs.  In  patients 
labouring  under  gastrorrhoea  we  find  the  epigastric  region  some- 
times indolent,  at  others,  hot  and  tender;  weight  and  constricting 
pains  exist  in  the  stomach,  and  a  nausea,  varying  in  its  duration 
and  the  period  of  its  occurrence :  it  may  come  on  after  meals  or 
between  them,  may  continue  for  an  hour  or  two,  or  be  present 
during  the  whole  day.  Jn  many  persons  this  nausea  is  relieved 
by  eating,  particularly  of  high-seasoned  dishes;  and  it  only  again 
recurs  when  the  period  of  digestion  is  finished.  One  of  the  most 
common  attendants  upon  this  disease  is  a  vomiting  of  quantities  of 
adhesive  slimy  mucus;  this  commonly  takes  place  early  in  the 
morning,  and  many  persons  are  unable  to  take  food  till  the  stomach 
has  discharged  the  mucus  secreted  during  the  night.  Again,  the 
vomiting  comes  on  at  various  periods  during  the  day;  but  its  most 
ordinary  appearance  is  when  the  stomach  is  empty,  between  meals, 
and  not  immediately  after  them.  This  vomiting  may  continue  for 
a  long  period,  and  not  appear  to  be  attended  with  any  serious  con- 
sequences. I  have  known  it  occur  daily  for  months,  and  the 
patient  preserve  the  appetite  and  not  grow  thin. 

The  tongue  is  generally  broad,  pale,  and  flabby,  or  loaded  with 
a  thick  fur.  It  may  assume  a  red  appearance,  and  become  con- 
tracted, if  the  disease  be  combined  with  vascular  irritation  or  in- 
flammation. Constipation  may  be  present,  or  the  patient  harassed 
with  a  teazing  diarrhoea;  sometimes  these  states  alternate  one  with 
the  other. 

The  pulse  is  scarcely  affected  in  the  simpler  forms  of  this  affec- 
tion, and  the  sympathetic  irritations,  with  the  exception  of  cough, 
which  is  commonly  an  attendant  symptom,  are  not  so  well  marked 
as  in  other  forms  of  gastric  disease. 

In  many  forms  of  gastrorrhosa  the  secretions  do  not  offer  any 
marked  change' in  their  character  ;  but  there  are  other  conditions 
in  which  they  are  intensely  acid,  and  contain  large  proportions  of 
acetic  and  muriatic  acids.  For  examples  of  these  forms  I  refer  the 
reader  to  Case  4,  page  41,  for  an  example  of  this  combination  with 
a  nervous  affection  of  the  stomach  ;  and  to  Case  7,  in  the  last  sec- 
tion, for  a  similar  combination  with  inflammation. 

Gastrorrhoea  is  a  disease  peculiar  to  adult  age,  and  hence  its 
causes  are  to  be  sought  for  in  circumstances  which  act  upon  us  at 
this  period,  and  which  do  not  influence  the  constitution  of  the 
child  or  the  youth,  in  whom  it  is  never  or  very  rarely  found. 
These  causes  are,  moral  impressions,  and  an  over-stimulating  or  too 
relaxing  a  diet.  I  have  frequently  noticed  that  anxiety,  or  strong 
mental  impression,  or  excessive  bodily  fatigue,  would  produce  this 
affection  in  persons  liable  to  it.  Roche  assures  us  that  it  is  more 
frequent  in  persons  addicted  to  the  use  of  wines  or  spirituous 
liquors,  particularly  those  who  are  in  the  habit  of  taking  them 


MORBID  STATES  OF  ITS  SECRETIONS.  65 

fasting.  In  such  cases  the  stomach,  whose  irritability  and  tone 
are,  in  a  great  measure,  destroyed,  does  not  inflame  under  the 
repeated  action  of  stimuli,  but  assumes  another  form  of  irritation 
in  secreting,  sometimes  to  an  enormous  extent,  fluids,  of  the  cha- 
racter of  which  we  have  been  speaking. 

The  treatment  of  gastrorrhoea  must  be  varied  to  suit  the  parti- 
cular form  it  assumes,  and  the  nature  of  its  combinations.  Should 
it  appear  as  a  primitive  affection,  uncombined  with  either  nervous 
or  vascular  irritation,  it  commonly  gives  way  to  warm  aperients, 
followed  up  by  bitters  and  the  mineral  acids.  In  some  instances 
purgatives  are  totally  useless,  particularly  when  diarrhoea  is  an 
accompanying  symptom ;  then  emetics  are  often  found  signally 
beneficial,  as  the  cases  detailed  by  Stoll,  Andral,  De  Larroque, 
Roche,  and  myself,  sufficiently  prove.  Roche  has  recommended 
opiates  and  magnesia,  calomel,  the  balsams  of  tolu  and  copaiba. 
If  the  superabundant  secretion  be  dependent  upon,  or  associated 
with,  morbid  conditions  of  the  sensibility  of  the  stomach,  the  latter 
symptoms  will  demand  our  first  attention ;  and  in  most  instances 
of  this  kind  neither  emetics  nor  violent  aperients  are  admissible. 
In  such  cases  the  combination  of  magnesia  or  chalk  with  calumba 
bismuth  or  morphia,  are  most  useful.  I  have  generally  found  the 
prepared  chalk,  given  with  the  hydrocyanic  acid  or  morphia,  more 
useful  in  such  states  than  almost  any  other  remedy. 

When  the  disease  is  manifestly  combined  with  inflammation  or 
hyperemia,  our  first  indications  are  to  remove  the  local  determina- 
tion of  blood,  to  correct  the  morbid  states  of  the  secretions  by  such 
mild  remedies  as  those  recommended  above,  and,  when  the  inflam- 
mation has  subsided,  to  administer  freely  the  mineral  acids  or 
quinine,  with  a  view  of  correcting  the  disposition  to  a  recurrence 
of  the  disease. 

M.  Rene  Prus  and  Andral  have  recommended  the  daily  exhibi- 
tion of  opiates  in  some  forms  of  gastrorrhoea  in  which  habitual 
vomiting  was  present.  The  practice,  in  their  hands,  appears  to 
have  been  successful.  I  have  commonly  seen  one  single  dose 
check  a  vomiting  which  has  been  daily  present  for  weeks. 

Besides  its  customary  follicular  and  mucous  fluids,  the  stomach 
secretes  air,  a  certain  quantity  of  which  is  constantly  found,  but 
which,  in  various  states  of  the  economy  and  of  the  stomach,  some- 
times accumulates  to  so  great  an  extent  as  to  render  this  symptom 
a  special  object  of  attention.  This,  like  most  of  the  other  symp- 
toms indicative  of  either  lesions  of  function  or  structure  in  the 
stomach  or  its  coats,  may  occur  in  every  possible  condition  of  the 
mucous  membrane,  and  also  when  the  vascular  and  nervous  sys- 
tems of  the  stomach  are  in  two  opposite  conditions  of  derangement. 
The  accumulations  of  air  in  the  stomach  are  sometimes  so  great 
that  the  degree  of  distension  produced  by  them  contracts  the  cavity 
of  t}ie  chest  by  pushing  upwards  the  diaphragm;  and  hence  we 
observe  various  changes  from  the  natural  character  of  the  breath- 
ing, and  irregularities  in  the  action  of  the  heart.  This  disposition 
10—  c  park  5 


66  PARKER  ON  THE  STOMACH. 

to  the  excessive  secretion  of  air  must  be  treated  in  relation  to  the 
exact  pathologic  condition  of  the  mucous  membrane  upon  which  it 
appears  to  depend.  If  a  symptom  of  a  nervous  affection  it  may 
depend  either  upon  atony  or  erethism  of  the  nerves  of  the  sto- 
mach ;  we  may  find  it,  also,  equally  present  with  an  increased  or 
diminished  quantity  of  blood.  This  distension  from  gaseous  or 
aeriform  accumulation  is,  to  many  persons,  most  distressing,  but  it 
gives  way  with  the  particular  morbid  state  upon  which  it  depends. 
In  some  instances  it  is  cured  by  leeches,  blisters,  or  warm  aperi- 
ents ;  in  others,  yields  only  to  quinine  and  the  preparations  of 
iron. 


CHAPTER  VII. 

ON  THE  INFLUENCE  OF  THE  STOMACH  UPON  OTHER  ORGANS. 

I. —  On  the  Influence  of  the  Stomach  upon  the  Liver. 

The  function  of  digestion  is  performed  by  the  concurrent  action 
of  the  secretions  of  the  stomach,  and  the  fluids  poured  out  by  cer- 
tain glands  into  the  first  portions  of  the  alimentary  canal.  These 
glands  are  the  salivary,  the  pancreas,  and  the  liver.  For  the  per- 
fect digestion  of  food  it  is  necessary  that  the  substances  taken  as 
aliment  should  exercise  a  certain  degree  of  stimulus  on  the  coats  of 
the  stomach,  to  enable  it  to  throw  out  a  secretion  sufficiently  pow- 
erful and  plentiful  for  their  digestion.  The  degree  of  the  solvent 
qualities  of  the  gastric  fluids  secreted  during  digestion  is  in  direct 
relation  to  the  stimulating  character  of  the  food,  as  the  researches 
of  Drs.  Prout  and  Beaumont,  Tiedemann  and  Gmelin,  Lauret  and 
Lassaigne,  have  sufficiently  established.  If  the  stimulating  cha- 
racter of  the  food  pass  a  certain  point,  a  degree  of  irritation  is  pro- 
duced, which  assumes  the  inflammatory  form,  and  which  deter- 
mining an  undue  quantity  of  blood  into  the  mucous  coat  of  the 
stomach,  reacts  upon  the  heart,  quickens  its  pulsations,  and  deter- 
mines a  temporary  febrile  state  of  greater  or  less  intensity,  and  of 
longer  or  shorter  duration.  To  this  morbid  state  Andral  has 
applied  the  term  "  gastric  hyperemia  ;"  among  the  French  gene- 
rally it  is  termed  "  embarras  gastrique,"  and  by  the  English  "  in- 
digestion." Both  the  latter  terms,  however,  are  vague  and  indefi- 
nite, and  may  be  applied  to  many  morbid  states  in  which  fulness  of 
blood  is  not  a  pathognomonic  character  of  the  disease.  The  writers 
of  the  French  physiological  school  consider  this  condition  of  the 
stomach  as  a  first  and  evanescent  form  of  inflammation  ;  and  many 
modern  writers  of  the  English  school  admit  the  inflammatory  form 
of  indigestion,  which  has  become  permanent  from  a  too  frequent 


ITS  INFUENCE  UPON  OTHER  ORGANS.  67 

repetition  of  the  causes  which  have  determined,  in  the  first  in- 
stance, this  form  and  degree  of  gastric  irritation.  Such  is  the 
state  of  things  as  far  as  the  stomach  is  concerned ;  but,  from  the 
intimate  connection  of  the  stomach  with  other  organs,  the  nature 
and  peculiarity  of  those  connections,  a'nd  the  character  of  its  func- 
tions and  sympathies,  we  find  that,  in  a  great  majority  of  in- 
stances, the  irritation  once  produced  is  not  limited  to  the  stomach, 
but  is  transmitted,  in  a  manner  about  to  be  mentioned,  to  other 
organs.  The  first  organ  which  demands  our  attention  in  this  en- 
quiry is  the  liver.  The  liver  is  more  immediately  connected  with 
the  stomach  by  similarity  of  function  than  any  other  organ,  though 
its  actions  are  not  limited  strictly  to  the  secretion  of  £ile.  Hence, 
the  greater  the  demands  made  upon  the  powers  of  the  stomach 
during  digestion,  the  more  is  the  secreting  power  of  the  liver  aug- 
mented. Increased  secretion  rarely  goes  on  without  an  increased 
determination  of  blood  to  the  secreting  organ  ;  from  this  circum- 
stance an  undue  secretion  of  bile  is  accompanied  generally  by  a 
local  determination  of  blood  to  the  liver.  This  is  another  primitive 
morbid  state,  and  to  it  Andral  has  applied  the  name  of  "  bilious 
hyperemia." 

It  is  difficult  to  conceive  of  any  impressions  being  made  upon 
our  organs,  except  through  the  medium  of  the  skin  without  or  the 
mucous  membranes  within.  Hence  the  impression  of  a  sapid  sub- 
stance of  the  tongue  determines  an  increased  secretion  from  the 
salivary  glands  ;  and  in  the  same  manner  the  presence  of  stimu- 
lating or  irritating  substances  on  the  mucous  surfaces  of  the  sto- 
mach and  duodenum  necessarily  induce  an  increase  in  the  secretion 
of  the  bile.  The  mode  of  transmission  of  irritation  from  the  sto- 
mach and  duodenum  to  the  liver  is  evidently  in  that  way  which 
John  Hunter  named  "continuous  sympathy" — i.e.  from  the  mu- 
cous surfaces  of  the  stomach  to  those  of  the  duodenum,  and  thence 
through  the  common  and  hepatic  ducts  to  the  liver. 

"The  liver,"  says  Broussais,1  "is  only  affected  consecutively  to 
the  stomach,  the  small  intestines,  and  the  duodenum."  Thus  the 
increased  secretion  from  this  organ  is  produced,  during  the  conti- 
nuance of  inflammatory  or  hyperemic  affections  of  the  mucous  sur- 
faces of  the  stomach  and  duodenum,  in  the  same  manner  as  during 
the  act  of  digestion — by  irritation  or  stimulus  of  these  parts  spread- 
ing thence  to  the  liver.  "  When  the  pyloric  portion  of  the  stomach 
or  the  duodenum  are  in  a  state  of  inflammatory  irritation,  the  liver 
is  more  influenced  than  when  this  irritation  exists  in  any  other 
part  of  the  alimentary  canal."3  By  referring  to  the  chapter  on  the 
co-existing  pathologic  conditions  of  these  two  organs,  we  shall  see 
that  cancerous  diseases  of  the  pylorus  and  liver  are  commonly 
found  together.  The  explanation  given  by  Broussais  of  the  causes 
of  hepatic  diseases,  although  borne  out  by  facts,  and  receiving  the 

1  Coraraentaires  des  Propositions  de  Pathologic,  Prop.  149,  150. 

2  Broussais,  Op.  cit. 


68  PARKER  ON  THE  STOMACH. 

support  of  many  pathologisfs,  does  not  fully  or  completely  explain 
the  mode  in  which  a  diseased  or  irritated  stomach  influences  the 
liver.  M.  Ribes,  whose  opinions  have  been  corroborated  by  An- 
dral  and  Cruveilhier,  discovered  that  inflammatory  irritation  of  the 
stomach  was  sometimes  propagated  from  the  stomach  to  the  liver, 
through  the  medium  of  the  veins.  It  may  be  readily  conceived 
how  excitement  habitually  produced  in  the  digestive  organs  may 
extend  by  continuity  of  tissue  to  the  mucous  membrane  of  the 
excretory  bile  ducts,  and  thence  to  the  substance  of  the  liver. 
Again,  it  would  be  possible  that,  under  the  circumstances  of 
habitual  stimulus,  the  irritation  might  extend  from  the  stomach 
and  intestines  to  the  liver,  through  the  medium  of  venous  inflam- 
mat  on.1  M.  Ribes  thinks  that  in  gastro-intestinal  inflammations, 
the  veins  which  arise  on  the  surface  of  the  mucous  membrane 
of  the  stomach  would  first  be  attacked  by  inflammation,  and  that 
this  might  extend  from  the  small  mesaraic  veins  to  the  trunk  of 
the  vena  portse,  and  thus  to  the  substance  of  the  liver.  Andral 
and  Cruveilhier  have  both  met  with  cases  confirming  this  view. 
The  same  opinions  are  supported  by  Broussais  in  his  Cours  de 
Pathologic  et  de  Therapeutique  Generates2  Persons  in  the  habit 
of  consuming  'arge  quantities  of  food  keep  the  mucous  surfaces  of 
the  stomach  constantly  turgid  with  blood.  This  state  is  the  first 
form  of  inflammation,  and  explains  the  remark  made  by  Portal, 
that  great  eaters  have  invariably  large  or  hypertrophied  livers.  In 
such  cases  the  tongue  is  generally  dry  arid  foul,  its  papillae  deve- 
loped, and  the  epigastric  region  hot  and  tender. 

II.—  On  the  Physiological  Action  of  the  Stomach  upon  the  Lungs. 

The  chemical  functions  of  respiration,  and  the  function  of  diges- 
tion, which  is  strictly  chemical  in  one  part  of  its  process,  go  on 
under  the  influence  of  nerves  derived  from  the  same  source,  which 
are  principally  destined  to  the  stomach  and  lungs.  Owing  to  this 
anatomical  fact,  we  sometimes  find  that  irritation  of  the  gastric 
portion  of  the  vagus  nerve  commonly  produces  a  correspoding  irri- 
tation in  the  parts  of  this  nerve  which  supply  the  lung;  hence  we 
have  hurried  breathing,  cough,  and  various  disturbances  of  the 
function  of  respiration,  consequent  upon  stomach  affections,  whe- 
ther these  consist  in  inflammation,  in  nervous  irritability,  or  from 
the  accidental  presence  of  a  worm  in  the  stomach.  These  func- 
tional disturbances  are  sometimes  followed  by  actual  states  of  dis- 
ease. Thus,  Andy3  has  reported  a  case  of  pleurisy  caused  by  the 
presence  of  a  worm  in  the  stomach  ;  De  Larroque4  one  from  large 


1  See  Andral,  Clinique  Medicate,  by  Spillan,  p.  918. 

2  Tome  iii,  p.  302. 

3  De  la  Generation  des  Vers,  p.  130. 

4De   Q,uelques   Maladies  Abdominales  qui  simulent,  &c.,  Maladies  de 
Poitrine.     Paris,  1831. 


ITS  INFLUENCE  UPON  OTHER  ORGANS.  69 

doses  of  the  oxymuriate  of  mercury  ;  Lombard1  has  recorded  several 
cases  of  cancer  of  the  stomach  in  which  the  whole  pulmonary 
branches  of  the  pneumo-gastric  nerve  were  enlarged  to  a  consider- 
able extent;  Lobstein2  others  in  which  the  branches  of  this  nerve 
were  inflamed,  either  in  consequence  of,  or  simultaneously  with,  a 
similar  condition  of  the  mucous  coat  of  the  stomach.  From  these 
facts  it  appears  that  the  integrity  of  the  lung  may  be  affected,  in 
the  first  instance,  by-  mere  irritation  of  the  gastric;  extremities  of 
the  pneumo-gastric  nerve,  which  may  not  be  limited  to  this  state, 
but  actually  progress  into  disease  of  the  inflammatory  kind,  or 
terminate  in  change  of  structure  of  the  nervous  trunk  itself.  The 
respiration  is  generally  quickened  after  a  hearty  meal,  at  the  same 
time  that  the  circulation  is  accelerated.  Cough,  at  other  times 
absent,  is  commonly  then  brought  on.  This  arises  from  the 
mechanical  distension  of  the  stomach  by  food  or  the  gases  evolved 
during  the  progress  of  digestion,  which,  pressing  upwards  the  dia- 
phragm, and  impeding  the  free  admission  of  air  to  the  lungs,  thus 
becomes  a  source  of  irritation  during  the  period  it  lasts.  The  im- 
mense distension  of  the  stomach  by  wind  in  hysterical  and  hypo- 
chondriacal  persons  thus  acts  upon  the  chest.  Irritating  or  indi- 
gestible food,  by  troubling  the  functions  of  the  stomach,  are 
productive  of  the  same  consequences;  hence  the  importance  of  a 
properly  regulated  diet  in  diseases*  of  the  lungs,  and  hence  the 
inutility  of  certain  medicines,  as  juleps,  syrups,  balsams,  and  olea- 
ginous mixtures,  given  in  affections  of  the  chest.  These  com- 
pounds, being  acted  upon  with  difficulty  by  the  powers  of  the 
stomach,  are  sometimes  actually  hurtful  to  the  affection  of  the  lung, 
from  the  gastric  irritation  they  create.  Andral  has  remarked  their 
inutility  in  phthisis,  and  De  Larroque  details  many  cases  of  their 
positive  injury,  in  increasing  the  cough  and  pectoral  disturbance 
they  were  given  to  allay.  In  all  pulmo'nary  diseases  the  medicines, 
as  well  as  the  food,  should  be  easily  digestible. 

Irritation  of  the  diaphragm,  the  result  of  gastric  derangement, 
becomes  a  frequent  source  of  disorder  to  the  function  of  respiration. 
De  Larroque  records  a  case  where  its  peritoneal  surface  was  in- 
flamed from  long  continued  stomach  disease.  "Les  melancholiques 
eprouvent  un  resserrement  opiniatre  de  la  poitrine,  et  respirent  avec 
peine,  quoiqu'ils  aient  les  poumons  parfaitment  sains.  Chez  eux, 
1'irritation  du  diaphragme  est  tellement  augmentee,  qu'ils  eprouvent 
des  tiraillements  incommodes  dans  le  cieux  de  1'estomac,  et  dans 
les  hypochondres,  et  que  la  respiration  est  genee  ou  tres  precipitee."3 

No  symptom  is  more  commonly  attendant  on  an  inflamed  or  irri- 
tated state  of  the  stomach  than  a  dry  cough.  If  we  peruse  the 
work  of  M.  de  Larroque  on  those  abdominal  diseases  which  resem- 


1  "Clinique  Medicale  de  l'H6pital  Civil  et  Militaire  de  Geneve."— Gazette 
Medicale  de  Paris.     Janvier,  1837. 

2De  Nervi  Sympathetic!  Fabric^,  Usu,  et  Morbis,  Commentatio,  &c. 
'Portal,  Cours  d'Anatomie  Medicale,  tome  iv.,  p.  135. 


70  PARKER  ON  THE  STOMACH. 

ble,  produce,  or  keep  up,  diseases  of  the  chest,  we  shall  at  once  see 
that  many  of  the  forms  of  cough  which  are  supposed  to  be  pectoral 
are  actually  of  gastric  origin.  The  first  effect  of  this  constant  and 
repeated  irritation  of  the  chest,  occasioned  by  violent  fits  of  cough- 
ing, is,  to  produce  a  certain  degree  of  congestion  of  blood  in  the 
mucous  membrane  of  the  bronchise,  and  subsequently  in  the  pul- 
monary vesicles.  This  is  the  first  stage  of  pneumonia,  bronchitis, 
and  their  consequences;  and  hence  many  of  these  affections,  at 
first  the  result  of  mere  irritation  of  the  gastric  branches  of  the 
pneu mo-gastric  nerve,  produce  irritation  of  the  lungs,  followed  by 
cough,  by  congestion  of  blood,  inflammatory  or  organic  disease. 
This  is  the  mechanism  of  the  production  of  pulmonary  diseases 
which  have  their  origin  in  the  stomach.  The  dissection  of  patients 
dying  from  gastric  diseases  accompanied  by  cough  shows  us  the 
lungs  or  bronchia  in  this  state;  a  congestion  of  blood  in  the 
mucous  membrane  in  the  latter,  and  also  in  the  substance  of  the 
former.1  The  bilious  pneumonia  spoken  of  first  by  Stoll,  and 
noticed  subsequently  by  Andral  and  Bouillnud,  has  evidently  this 
origin.  In  this  manner  are  irritations  which  commence  in  the 
nervous  system  succeeded  by  congestion  and  inflammation,  thus 
are  the  "lesions  of  innervation  followed  by  those  of  circulation," 
and  in  this  manner  may  a  simple  indigestion,  apparently  so  trivial, 
lay  the  foundation  of  organic  disease  of  the  lungs.2  The  most 
common  source  of  pulmonary  irritation  commencing  in  the  stomach 
is  evidently  nervous  irritation,  which,  determining  an  increased 
quantity  of  blood  into  the  coats  of  the  stomach,  terminates  in  con- 
gestion or  inflammation.  The  affections  of  the  mucous  membrane 
of  the  lungs,  which  succeed  to  those  of  the  stomach,  are,  again, 
produced  under  the  influence  of  that  law  which  disposes  diseases 
to  spread  by  similarity  of  tissue.  Thus,  we  hardly  ever  see  a  pro- 
tracted affection  of  the  mucous  coat  of  the  stomach  without  an  irri- 
table or  inflamed  state  of  that  of  the  lungs.  Those  parts  of  the 
body  which  are  of  a  similar  anatomical  organisation  have  a  natural 
tendency  to  sympathise  with  each  other  more  freely  than  others  in 
which  no  similarity  of  organisation  exists  ;  they  also  exhibit  a  tend- 
ency to  be  acted  upon  by  the  same  irritating  causes.  Hence  we 
observe  that  those  persons  who  exhibit  a  natural  tendency  to  intes- 
tinal irritation,  under  the  form  of  repeated  diarrhoeas,  arising  from 
slight  dietetic  errors,  have  at  the  same  time  a  similar  tendency  to 
irritation  of  the  mucous  surfaces  of  the  lungs,  which  often  termi- 
nate in  phthisis,  of  which  this  intestinal  irritation  is  the  first  indi- 
cation. This  is  also  well  exemplified  in  the  sympathies  of  the 
mucous  membranes  of  the  lungs  with  those  of  the  digestive  passages, 
and  also  in  the  frequent  and  simultaneous  origin  of  disease  in  both, 


*See  Broussais,  Traite  de  Physiologie  appliquee  a  la  Pathologie,  tome  ii., 
p.  70,  et  suivautes. 

1  See  the  Remarks  of  Portal,  Op.  cit.,  torne  v.,  p.  194,  and  the  corroborative 
testimony  of  Lieutaud,  Morgagni,  and  Storck. 


ITS  INFLUENCE  UPON  OTHER  ORGANS.  71 

as  noticed  by  Copland  and  others.  The  same  cause  which  produces 
a  gastritis  will,  at  the  same  time,  produce  a  bronchitis ;  the  conti- 
nuation of  inflammation  of  the  mucous  membrane  of  the  stomach 
for  a  certain  period  is,  in  many  individuals,  followed  by  acute  or 
chronic  disease  of  the  same  parts  in  the  lungs,  as  my  own  cases, 
with  those  of  Andral,  Larroque,  and  Broussais,  sufficiently  prove.1 

These  are  the  modes  in  which  the  sympathies  existing  between 
the  lungs  and  stomach  are  exercised,  and  these  sympathies  may  be 
called  forth  from  several  sources  of  irritation  in  the  stomach;  from 
the  presence  of  foreign  bodies,  as  worms,  from  indigestible  food  or 
medicine,  or  from  varied  forms  of  actually  existing  disease. 

There  are.  however,  other  ways  in  which  the  stomach  influences 
the  lung;  these,  however,  are  rather  mechanical  than  vital.  Thus, 
the  distension  of  this  viscus  by  an  undue  quantity  of  food,  the  gases 
evolved  during  the  progress  of  digestion,  the  vast  collections  of 
wind  which  occur  in  hysterical  and  hypochondriacal  persons,  by 
pressing  upon  and  contracting  the  cavity  of  the  thorax,  and  irritat- 
ing the  diaphram,  become  a  fruitful  and  a  frequent  source  of 
derangement  in  the  functions  of  the  organs  of  respiration. 

III. —  Of  the  Physiological  Action  of  the  Stomach  upon  the  Heart. 

The  heart,  like  the  lungs,  is  influenced  by  the  stomach  in  the 
customary  integrity  of  its  functions,  in  two  ways,  mechanically  and 
vitally.  The  distension  of  the  stomach  by  food  or  gases,  contract- 
ing the  cavity  of  the  chest,  and  preventing  the  free  discharge  of 
blood  from  the  right  side  of  the  heart,  naturally  deranges  the  action 
of  this  organ:  and  hence,  from  this  cause,  we  observe  laboured, 
quickened,  or  irregular  action  of  the  heart,  frequently  come  on, 
where  the  stomach  is  free  from  complaint,  after  a  meal.  The 
quantity  of  food  which  may  be  taken  without  exciting  the  heart's 
action  is  variable,  and  may  depend,  in  many  instances,  upon  the 
size  of  the  stomach,  no  organ  being  so  variable  in  its  capacity  as 
this.  I  have  been  frequently  consulted  by  a  gentleman  who  pre- 
sents none  of  the  physical  signs  of  disease  of  the  heart  in  whom  a 
tea-cupful  of  common  groat  gruel  will  excite  the  action  of  the 
heart  to  a  very  distressing  degree,  whilst  a  less  quantity  does  not 
do  so.  The  position  of  the  body  after  a  meal,  when  the  stomach  is 
full,  has  a  marked  effect  upon  the  action  of  the  heart.  Portal2 
remarks  that  in  persons  whose  occupations  lead  them  to  work  with 
the  stomach  pressed  against  a  desk  or  counter — as  literary  men, 
and  some  mechanics — or  those  who  sit  with  the  body  doubled  for 

^Lallemand  details  some  instructive  examples  of  the  simultaneous  and 
consecutive  occurrence  of  disease  in  the  serous  membranes  of  the  abdomen, 
l!ie  chest,  and  the  head.  See  Recherches,  &c.,  de  1'Encephale,  Lettre  2me. 
Des  tissues  de  meme  nature,  remplissant  des  fonctions  semblables,  soumis  a 
la  meme  influence,  doivent  etre  egalement  exposes  a  contracter  la  meme 
maladie — Page  155. 

2  Op.  cit.,  tome  viii.,  p.  101. 


72  PARKER  ON  THE  STOMACH. 

wards — as  tailors  or  shoemakers — the  stomach  is  pressed,  by  the 
position  of  the  body,  against  the  diaphragm ;  the  capacity  of  the 
chest  is  consequently  contracted,  and  the  passage  of  the  blood 
through  the  heart  impeded.  To  this  circumstance  this  author 
attributes  frequent  dilatations  of  this  organ.  Precisely  similar 
effects  are  produced  by  tight  lacing,  which,  preventing  the  usual 
motion  of  the  stomach  forwards  when  it  becomes  distended  by  food, 
forces  it  upwards  against  the  diaphragm,  and,  preventing  the  free 
discharge  of  blood  from  the  heart,  gives  rise  to  palpitations  and 
irregular  actions,  which  sometimes  terminate  in  organic  disease. 
It  is  this  mechanical  distension  of  the  stomach  which  becomes  so 
dangerous  to  persons  affected  with  organic  diseases  of  the  heart; 
and  we  commonly  observe  it  to  produce  a  fatal  embarrassment  of 
its  actions.  We  often  see  persons  carrying  about  them  these  dis- 
eases die  suddenly,  from  this  cause,  after  a  full  meal.  I  have  for 
some  time  attended  a  gentleman  who  at  first  consulted  me  for  dis- 
tressing palpitations,  which  came  on  after  his  meals.  On  examin- 
ing the  heart  physical  signs  of  valvular  disease,  evidenced  by  a 
strong  "bruit  de  soufflet,"  were  detected.  By  depriving  him  of 
stimulants,  and  limiting  him  to  a  small  quantity  of  food  at  a  time, 
the  palpitations  have  disappeared,  although  the  physical  signs  of 
disease  remain.  It  is  thus  that  we  may  retard  or  prevent  the  fatal 
termination  of  diseases,  if  aware  of  their  true  nature,  and  the  in- 
fluence of  other  organs  upon  the  one  diseased.  I  have  seen  several 
other  patients,  in  precisely  similar  states,  relieved  to  such  an  extent 
by  the  same  means,  and  occasionally  leeching  the  epigastrium  and 
region  of  the  heart,  as  occasion  might  require,  that  they  have  fancied 
themselves  perfectly  free  from  complaint. 

The  first  effect  of  eating,  as  we  have  before  said,  alluding  to  the 
physiologi9al  action  of  the  stomach  upon  the  liver,  is  to  determine 
an  increased  quantity  of  blood  to  the  mucous  coat  of  the  stomach, 
and  also  to  all  the  organs  concerned  in  the  function  of  digestion. 
This  determination  of  blood  is  produced  by  the  food  stimulating 
the  stomach.  If  a  hearty  meal  be  taken,  the  action  of  the  heart  is 
accelerated  to  a  greater  or  less  degree,  its  pulsations  are  quickened, 
the  heat  of  the  skin  is  slightly  augmented,  and  a  temporary  degree 
of  arterial  excitement  is  produced,  which  continues  whilst  the  period 
of  digestion  lasts.  The  degree  of  this  excitement  depends  upon 
the  degree  of  irritability  which  the  stomach  naturally  possesses, 
and  also  upon  that  with  which  the  heart  is  endued:  we  shall  see, 
by  reference  to  the  cases  in  the  pathologic  part  of  this  work,  that  indi- 
viduals vary  extremely  in  the  degree  of  irritability  of  these  two 
organs.  So  far  digestion  does  not  affect  the  heart  or  arterial  system, 
further  than  by  producing  a  slight,  but  regular,  increase  of  their  pul- 
sations. Under  the  influence,  however,  of  an  undue  quantity  of 
food,  of  too  stimulating  or  indigestible  character,  we  find  a  degree 
of  irritation  set  up,  from  which  the  mucous  coat  becomes  still  fuller 
of  blood,  the  heart  more  excited  than  in  the  first  state,  and  its  bsats 
hurried  or  irregular.  In  many  individuals  we  may  observe  that 


ITS  INFLUENCE  UPON  OTHER  ORGANS. 


73 


the  pulse  constantly  intermits  whilst  the  period  of  digestion  lasts; 
and  in  others  the  increase  of  the  .heats  of  the  heart  during  the  con- 
tinuance of  this  function  amounts  to  a  distressing  state  of  palpita- 
tion. In  both  these  instances  careful  examination  by  auscultation 
can  detect  no  evidence  of  disease  in  the  heart,  although  it  appears, 
from  the  ease  with  which  its  functions  are  made  irregular  and  its 
rythm  disturbed,  that  a  predisposition  to  disease  exists.  Some  phy- 
siologists, amongst  whom  are  Broussais  and  Andral,  attribute  this 
irritability  of  the  heart  to  a  preternatural  thickness  of  its  walls,  or 
an  over-excitable  state  of  the  nervous  system  distributed  to  it.  How 
often  are  such  symptoms  the  first  indications  of  hypertrophy,  of 
softening,  of  valvular  disease,  or  affections  of  the  investing  or 
lining  membranes  of  this  organ! 

In  many  persons  who  die  of  gastric  diseases,  we  notice  the  peri- 
cardium intimately  adherent  to  the  muscular  substance  of  the  heart; 
in  others,  this  substance  pale  and  softened  ;  whilst  in  a  third 
series  varied  forms  of  disease  in  its  lining  membrane  arid  valves  are 
present. 

What  we  observe  to  take  place  during  the  period  of  digestion, 
when  the  stomach  is  healthy,  also  occurs  from  other  modes  of 
excitement,  and  also  during  the  progress  of  many  forms  of  disease; 
amongst  the  former,  moral  causes  play  a  prominent  and  important 
part.  In  the  various  forms  of  gastritis,  or  gastric  hyperemia, 
occurring  idiopathically  or  in  conjunction  with  various  morbid 
states  of  the  economy,  particularly  those  noticed  at  the  commence- 
ment of  various  forms  of  fever,  we  observe  the  heart  thus  excited  or 
irregular.  I  have  detailed  many  peculiar  forms  of  these  affections 
in  the  subsequent  pages.  That  these  irregular  or  excessive  actions 
of  the  heart  and  arteries  are  dependent  upon  gastric  irritation,  and 
not  upon  the  general  morbid  state  of  the  economy  existing  at  the 
time  when  they  occur,  is  evident  from  their  commonly  subsiding 
under  the  use  of  local  depletions  from  the  epigastrium,  whilst  the 
general  disease,  as  fever,  runs  its  usual  course.  The  heart,  when 
once  rendered  tumultuous  or  irregular  by  the  irritation  existing  in 
the  stomach,  reacts  upon  this  organ  through  the  medium  of  the 
liver,  and  produces  congestion  of  blood  in  the  whole  venous  system 
of  the  abdomen.  When  the  heart's  action  is  rendered  irregular  and 
hurried  from  gastric  irritation,  or  from  other  causes,  the  first  effect 
produced  is  an  impediment  to  the  free  passage  of  blood  through  its 
cavities.  This  may  arise  from  contraction  of  its  cavities  from  spasm 
during  the  fits  of  palpitation,  as  some  physiologists  seem  disposed  to 
admit,  or  from  other  causes.  Whatever  these  may  be,  we  find  that, 
during  the  continuance  of  the  irregular  action  of  the  heart,  there  is 
an  impediment  offered  to  the  passage  of  blood  through  it  as 
long  as  the  fits  of  palpitation  or  irregular  action  last.  Hence  the 
sense  of  suffocation,  the  inability  to  lie  down,  the  difficulty  of 
breathing,  and  other  symptoms  which  attend  them  ;  and  hence  is  it 
that  we  see  the  symptoms  dependent  upon  actual  organic  disease  of 
the  heart  aggravated  during  the  continuance  of  gastric  irritation,  of 


74  PARKER    ON    THE    STOMACH. 

which  we  shall  see  many  examples  under  this  division  of  our 
subject.  The  impediment  offered  by  the  heart  to  the  passage  of 
blood  through  it  produces  a  mechanical  congestion  of  this  fluid  in 
the  liver,  and  consequently  in  the  veins  of  the  mucous  surfaces  of 
the  stomach  and  duodenum.  With  the  accumulation  of  blood  in 
these  organs  we  commonly  find  an  exalted  state  of  the  sensibility  ; 
the  hepatic  region  is  commonly  full,  and  that  of  the  epigastrium  hot 
and  tender.  It  is  the  production  of  this  state  of  stomach  during 
these  states  of  the  heart's  action  that  renders  the  exhibition  of  certain 
remedies,  in  such  circumstances,  inadmissible.1 

IV. —  On  the  Physiological  Action  of  the  Siomach  upon  the  Brain. 

The  mass  of  nervous  matter  existing  in  the  cranium,  and  that 
assemblage  of  ganglia  and  plexuses  placed  in  the  epigastric  region, 
behind  the  stomach,  to  which  Lobstein  has  applied  the  term 
u  Cerebrum  abdominale,"  bear  a  strict  relation  to  each  other,  and 
are  connected  by  certain  sympathies  which  it  is  important  to  note, 
both  in  health  and  in  disease.  The  sensibilities  of  the  nervous 
centres  of  the  epigastrium  appear  to  be  excited  chiefly  through  the 
medium  of  the  mucous  surfaces  of  the  stomach  ;  and  the  sympathies 
which  connect  this  portion  of  the  nervous  system  with  others  are 
exercised,  in  a  great  majority  of  instances,  through  the  means  of 
impressions  made  upon  this  organ.  "  The  stomach,"  says  Broussais, 
"  is  a  curious  organ  ;  it  is  destined  always  to  be  irritated."2  He 
should  rather  have  said,  it  is  destined  always  to  be  stimulated  ;  for 
if  stimulus  amount  to  irritation,  -the  condition  of  the  organ  has 
passed  from  a  state  of  health  to  the  first  commencement  of  disease. 
All  organs  require  a  certain  degree  of  stimulus  to  preserve  them  in 
action  ;  without  this  stimulus  they  languish  and  become  weak,  with 
an  excess  of  it  they  become  irritated  and  diseased.  Independent  of 
the  external  stimuli  which  act  upon  our  several  organs,  as  light 
upon  the  eye,  sounds  upon  the  ear,  sapid  bodies  upon  the  tongue, 
<fcc.,  every  organ  requires  that  a  certain  proportion  of  healthy 
arterial  blood  be  distributed  to  it,  in  order  that  it  may  properly  act; 
and  whether  this  blood  be  furnished  in  excess  or  diminution,  in  a 
greater  or  less  quantity  than  is  necessary  to  the  due  fulfilment  of 
the  functions  of  the  organ,  a  diseased  condition  is  the  result.  This 
is  precisely  the  case  with  the  stomach  in  many  of  its  primitive 
morbid  states,  and  their  influence  upon  the  brain.  I  have  given 
some  cases  in  this  work  illustrative  of  the  symptoms  of  diseases 
of  the  stomach  subsequent  to  large  losses  of  blood  from  the 
uterus,  &c.,  in  their  character  precisely  resembling  inflammatory 
diseases,  yet  which  yieldefl  quickly  to  the  exhibition  of  iron  and 

1  The  two  hundred  and  twelfth  aphorism  of  Broussais,  and  his  commen- 
tary upon  it  in  his  Commentaires  des  Propositions  de  Pathologic,  merit  par- 
ticular attention  on  this  point. 

2  Physiologic  appliquee  a  la  Pathologic. 


ITS  INFLUENCE  UPON  OTHER  ORGANS.  75 

other  tonics.  The  brain,  from  the  peculiarity  of  its  constitution, 
receives  its  stimuli  from  many  sources ;  from  moral  impressions, 
and  from  the  external  stimuli,  which  affect  it  through  the  medium 
of  its  organs  of  sense.  The  great  nervous  system  of  the  abdomen, 
however,  which,  in  conjunction  with  many  physiologists,  I  must 
consider  as  the  agent  of  sensibilities  peculiar  to  itself,  receives  its 
impression  chiefly  through  the  medium  of  the  mucous  surfaces  of 
the  stomach,  not  considering  it,  as  Bichat  did,  the  seat  of  the 
passions,  nor  admitting,  with  regard  to  it,  any  moral  impression 
further  than  is  conveyed  to  it  through  the  medium  of  the  brain. 
We  have  here  two  centres  of  sensation,  the  brain  and  the  nervous 
centres  of  the  epigastrium,  to  which  all  sensations,  both  external 
and  internal,  are  referred.  These  may  affect  one  centre  alone,  or 
be  transmitted  from  one  to  the  other.  The  phenomena  produced 
by  hunger  and  repletion  are  the  first  which  demand  our  attention. 
After  trie  stomach  has  been  deprived  for  a  certain  time  of  the 
presence  of  food,  it  contracts  upon  itself,  its  mucous  membrane 
becomes  pale,  and  the  circulation  in  this  organ,  as  well  as  in  the 
general  system  languid  ;  the  same  effect  is  produced  upon  the  brain. 
This  organ  now  receives  sufficient  biood  for  the  due  performance 
of  its  functions,  and  no  more ;  the  mind  is  clear,  the  operations  of 
the  senses  lively  and  acute,  and  the  intellectual  powers  can  be  most 
powerfully  and  judiciously  exercised.  If  the  abstinence  be  pro- 
longed, another  effect  is  produced :  the  mucous  surfaces  of  the 
stomach  become  dry,  red,  and  inflamed,  and  a  degree  of  mental  dis- 
tress is  induced  proportionate  to  the  physical  suffering  of  the  patient. 
I  have  remarked  conditions  of  the  stomach  resembling  this  produced 
from  excessive  discharges  of  blood  during  abortions,  or  after 
delivery.  In  some  of  these  instances,  which  I  have  detailed,  there 
has  been  intense  acidity,  and  acute  pain  in  the  epigastrium,  which 
was  hot,  tender,  and  highly  sensible.  These  cases  have,  as  I  have 
before  stated,  yielded  quickly  to  nutritious  diet  and  tonics ;  during 
their  continuance,  anxiety  and  restlessness  were  present.  In  one 
lady,  who  had  aborted  with  alarming  haemorrhage,  profound  coma 
succeeded  the  discharges ;  the  skin  was  perfectly  insensible  ;  she 
exhibited  no  sensibility  to  pain,  unless  the  epigastrium  were  pressed ; 
this  occasioned  great  uneasiness,  evidenced  by  her  countenance, 
and  convulsive  motions  of  the  limbs.  After  a  moderate  meal,  taken 
in  a  perfectly  healthy  state  of  the  stomach  and  economy  at  large, 
there  is  a  general  sentiment  of  ease  and  mental  quietude  induced  ; 
if  annoyances  had  previously  irritated  us  this  has  a  wonderful  effect 
in  allaying  them,  and  restoring  the  mind  to  its  customary  tone. 

The  circulation  is  now  slightly  accelerated,  the  force  of  the 
heart's  action  increased,  and  a  disposition  to  drowsiness,  and  aver- 
sion to  the  exercise  of  the  mind  comes  on.  If  the  meal  be  full  it 
induces,  in  many  people,  a  frontal  headach  during  the  period  of 
digestion. 

When  the  sensibility  of  the  mucous  surfaces  of  the  stomach 
becomes  deranged  from  fulness  of  blood  (hyperemia),  from  chronic 


76 


PARKER  ON  THE  STOMACH. 


inflammation,  or  from  other  causes,  the  influence  upon  the  brain 
becomes  much  more  varied  and  marked.  In  such  instances  we 
have  occasionally,  after  a  full  meal,  a  loss  of  some  or  the  whole  of 
the  mental  powers;  in  some,  depression;  in  others,  fits  of  excite- 
ment. The  functions  of  the  senses  become  impaired  or  exalted; 
some  see  spectres  or  visions,  and  others  are  profoundly  stupid.  In 
many  instances  apoplexy,  epilepsy,  or  effusion,  succeed  to  the  gas- 
tric irritation.  Of  all  these  forms  of  sympathetic  affections  of  the 
brain  I  have  seen,  and  shall  detail,  examples.2 

"It  is  notorious,"  says  Cabanis,  "that  in  certain  states  of  the 
digestive  organs  we  are  more  or  less  capable  of  exercising  the  in- 
tellectual faculties."  In  the  sympathetic  affections  of  other  organs 
which  accompany  diseased  conditions  of  the  lining  membrane  of 
the  stomach,  varied  conditions  of  the  mental  powers  are  some  of  the 
most  frequent.  In  some  persons  where  the  powers  of  the  mind  are 
naturally  acute,  they  are  singularly  depressed  after  a  full  meal  ; 
some  lose  the  faculty  of  thinking  at  all,  others  become  deficient  in 
judgment,  and  in  others,  again,  memory  is  quite  lost.  I  was  called 
to  the  case  of  a  gentleman,  in  the  course  of  last  year,  who  was 
suffering  from  a  subacute  inflammatory  affection  of  the  stomach, 
who  completely  lost  the  faculty  of  memory  after  taking  a  teacupful 
of  food;  yet  this  patient  was  remarkable  for  his  mechanical  genius. 
A  less  portion  of  food  did  not  impair  his  mind,  which  invariably 
became  more  powerful  and  clear  from  leeching  or  fomenting  the 
epigastrium. 

So  intimate  is  the  connection  between  the  brain  and  stomach, 
that  it  is  rare  not  to  see  some  change  produced  in  the  functions  of 
the  former  by  every  impression  made  upon  the  mucous  membrane 
of  the  latter  ;  these  changes,  however,  vary  with  the  natural  con- 
stitution of  the  mind,  and  the  varied  states  into  which  it  is  thrown 
by  the  circumstances  which  act  upon  it. 

Extreme  mental  depression  is  one  of  the  most  frequent  attend- 
ants upon  chronic  or  subacute  inflammation  of  the  stomach,  or 
upon  that  congested  or  excited  state  of  its  mucous  membrane  which 
follows  the  ingestion  of  aliment  bad  in  quality  or  excessive  in 
quantity.  Sometimes  these  states  of  mind  continue  during  the 
whole  progress  of  the  gastric  disease  ;  at  other  times  they  succed  to, 
or  are  aggravated  by,  a  meal;  and,  again,  I  have  frequently  seen 


1  Les  maladies  de  1'estomac  changent,  troublent,  intervertissent  entiere- 
ment  1'ordre  habituel  des  sentimens,  et  des  idees.  Des  appetits  extraordi- 
naires  et  bizarres  se  developpent:  des  images  inconnues  assiegent  1'esprit: 
des  affections  nouvelles  s'emparent  de  la  volonte;  et  ce  qu'il  y  a  de  plus  re- 
marquable,  c'est  que  souvent  1'intelligence  peut  acquerir  plus  d'energie, 
d'elevation,  d'eclat,  et  Pame  se  nourrir  d'affections  plus  touchante  ou  mieux 
dirigees.  Ainsi  done,  les  idees  riantes  ou  sombres,  les  sentimens  doux  ou 
cruels,  tiennent  alors  directement  a  la  maniere  dont  certains  visceres  ab- 
dominaux  exercent  leurs  fonctions,  c'est  a  dire  a  la  maniere  dont  ils  percoi- 
vent  les  impressions. — Richond,  Influence  de  1'Estomac  sur  la  Production 
d'Apoplexie.  Paris,  1824. 


ITS  INFLUENCE  UPON  OTHER  ORGANS.  77 

them  induced  by  strong1  aperient  medicines.  Fits  of  great  mental 
excitement,  on  the  contrary,  occasionally  succeed  to  diseases  of  this 
character ;  and  where  the  disease  is  protracted,  in  mental  constitu- 
tions so  predisposed,  infrequently  terminates  in  confirmed  insanity. 
I  have  detailed  one  or  two  remarkable  instances  of  this  kind  in  my 
paper  "  On  Stomach  Diseases  and  their  Sympathies,"  in  the  Dublin 
Medical  and  Chemical  Journal  for  September,  1835.  In  that  paper 
I  have  also  related  the  case  of  a  gentleman  who  had  intense  head- 
ach  dependent  upon  an  inflammatory  condition  of  the  stomach, 
who  imagined  that  the  paroxysms  of  pain  were  produced  by  a  black 
bird  flying  against  his  head. 

The  influence  of  the  stomach  upon  the  brain  is  not  confined 
merely  to  the  waking  state  ;  it  is  equally  marked  during  sleep. 
Persons  thus  suffering  we  find  constantly  troubled  with  dreams  of 
an  extremely  vivid  and  intense  character;  in  fact,  so  perfect  are 
the  scenes  of  many  of  these  dreams,  that  they  appear  to  the  patient 
rather  the  impressions  of  a  waking  hour  than  the  delusions  of  a 
dream. 

Let  us  examine  for  a  moment  the  state  of  the  organs  in  which 
these  functional  derangements  take  place.  Richon  and  others 
assure  us  that,  if  the  brains  of  persons  dying  from  gastric  diseases 
be  carefully  examined,  we  shall  find  numerous  pathologic  changes; 
the  arachnoid  thickened  or  injected,  separated  from  the  pia  mater 
by  effusions  of  serum,  pus,  or  blood  ;  the  sinuses  and  veins  of  the 
substance  of  the  brain  fuller  of  blood,  and  more  numerous  than  in 
the  healthy  state ;  and  the  brain  itself  commonly  altered  in  its 
texture,  being  sometimes  harder,  at  others  softer,  than  in  the  natural 
condition. 

If  we  carry  our  enquiry  to  the  examination  of  the  functions  of 
organs  during  life,  we  shall  find  that  increased  vascular  excitement 
is  commonly  determined  in  the  heart  and  great  vessels,  and  conse- 
quently in  the  brain,  by  diseased  conditions  of  the  stomach  ;  strong 
beating  in  the  epigastric  region,  increase  of  force  though  not  always 
of  frequency,  in  the  heart's  actions,  and  a  similar  excitement  in  the 
carotid  and  temporal  arteries.  This  state  of  the  circulation  is 
accompanied  by  increased  heat  of  the  head,  and  all  the  symptoms 
become  aggravated  during  the  accession  of  those  depending  upon 
the  affection  of  the  stomach.  During  fits  of  the  deepest  mental 
despondency  this  increase  in  the  force  of  action  in  the  arterial 
system  is  commonly  present,  vascular  excitement  by  no  means  bears 
a  strict  relation  to  mental  excitement  in  these  forms  of  disease;  such 
is  the  different  effect  produced  by  stimulus  upon  brains  or  minds 
differently  organised. 

I  must  consider,  as  I  have  before  said,  the  mucous  membrane  of 
the  stomach  to  be  the  seat  of  a  peculiar  sensibility,  upon  whose 
healthy  condition  is  dependent  the  integrity  of  all  the  other  organs 
of  the  economy.  Many  of  the  functions  of  this  sensibility  are,  how- 
ever, not  perfect  without  the  concurrent  action  of  the  brain.  Thus, 
some  physiologists,  as  Bronssais,  Desruelles,  &c.,  consider  the  feel- 


78  PARKER  ON  THE  STOMACH. 

ing  of  hunger  to  be  expressed  through  the  medium  of  the  nerves  of 
the  stomach ;  whilst  Georget,  Braschet,  &c.,  contend  that  we  are 
made  sensible  of  the  wants  of  our  organs  through  the  medium  of 
the  brain.  There  can  be  no  question  of  the  real  truth  of  the  case, 
which  is  that  the  sensation  of  hunger  is  produced  by  the  want  of 
stimulus  which  the  coats  of  the  stomach,  in  a  perfectly  healthy 
condition,  require ;  and  that  this  sensation  is  propagated  from  the 
nervous  centres  of  the  epigastrium  to  the  brain.  A  similar  error 
and  controversy  has  arisen  about  the  seat  of  the  passions ;  some,  as 
Bichat,  placing  them  in  the  epigastrium,  others  in  the  brain.  Here, 
again,  it  is  the  sensation  transmitted  to  the  brain  through  the 
medium  of  its  senses,  and  thence  to  the  nervous  centres  of  the  epi- 
gastrium, that  produces  that  sudden  pain  and  those  analogous  sen- 
sations we  sometimes  feel  in  the  stomach  from  strong  moral 
impression.  The  application  of  a  healthy  stimulus  is  required,  to 
keep  the  nerves  of  the  stomach  in  proper  action,  and,  this  done,  the 
functions  of  the  brain  remain  healthy.  Tf  this  stimulus  be  wanting 
to  the  stomach,  if  it  be  morbid,  if  it  be  in  excess,  if  it  be  in  diminu- 
tion, the  brain  instantly  is  aware  of  it  through  the  sympathies  which 
connect  these  two  nervous  centres.  Hence  the  varied  condition  of 
the  intellectual  powers,  the  loss  of  mind,  or  of  its  separate  parts 
or  faculties,  their  excess,  their  derangement,  the  displacement  of 
their  consent  and  unity  of  action,  which  we  observe  during  morbid 
states  of  the  sensibility  of  the  epigastric  centre.  The  stomach  is 
the  seat  of  an  internal  sense  which  holds  and  keeps  in  a  state 
of  equilibrium  the  actions  of  the  brain,  and  which  can  only 
transmit  healthy  sensations  to  the  brain  as  long  as  itself  is  healthy. 
The  first  influence  of  one  upon  the  other  is  nervous,  the  second 
vascular. 


CHAPTER  VIII. 

ON  THE  INFLUENCE  OP  MORBID  STATES  OF  THE  STOMACH  UPON 
THE  ORIGIN,  PROGRESS,  AND  TERMINATION,  OF  DISEASES  OF 
THE  LIVER. 

I.  —  On  the  Primary  Symptoms  of  Disease  of  the  Liver. 

The  symptoms  which  mark  the  commencement  and  progress  of 
hypertrophy  of  the  liver  are  sometimes  continued  through  a  long 
series  of  years  without  attracting  in  any  marked  manner,  the  at- 
tention of  the  subject  of  them.  He  is  constantly  suffering,  but 
never  seriously  ill,  till  the  occurrence  of  severe  vomiting,  diarrhoea, 
swelling  of  the  legs,  or  an  attack  of  jaundice,  attract  his  serious 
notice  and  alarm.  The  patients  who,  in  after  or  middle  life,  fall 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER.  79 

victims  to  hepatic  diseases,  have  generally  been  subject  from  youth 
to  great  irritability  of  the  stomach.  1  have  closely  questioned  per- 
sons who  have  come  under  my  care  with  marked  hypertrophy  of 
the  liver  in  advanced  or  middle  life,  and  have  invariably  found  that 
they  could  not  recollect  the  period  when  they  were  not  the  subjects 
of  some  form  of  indigestion.  These  persons  have  been  females  as 
well  as  males,  and  the  symptoms  of  gastric  irritation  have  developed 
themselves  under  circumstances  and  at  periods  so  early  that  they 
have  appeared  to  depend  entirely  upon  the  natural  organisation  of 
the  stomach,  and  not  to  have  been  called  into  existence  by  the  pro- 
longed or  excessive  use  of  stimuli  of  any  kind.  "There  are  some- 
times," says  Andral,  "persons  to  be  met  with  who  have  the  stomach 
constantly  irritable."  These  persons  have  commonly  a  sallow 
countenance,  a  tongue  habitually  loaded  and  dry,  and  seldom  pass 
many  days  without  haying  nausea  or  diarrhoea. 

In  enumerating  the  causes  which  produce  diseases  of  the  liver, 
Ferrus  and  P.  tL  Berard,  the  latest  writers  on  the  subject,  quoting 
the  authority  of  Portal,  attribute  simple  hypertrophy  or  enlargement 
of  the  liver  to  an  over-stimulating  diet;  the  liver  being  found 
invariably  in  persons  thus  indulging;  the  constant  irritation  kept 
up  in  the  stomach  by  large  quantities  of  food  received  into  it  deter- 
mining an.  increased  quantity  of  blood  into  all  the  organs  con- 
cerned in  digestion,  which  lays  the  foundation  for  most  of  their 
diseases. 

The  state  of  stomach,  however,  which  is  the  greatest  source  of 
irritation  to  the  liver,  is  that  in  which  there  is  a  permanent  excess 
of  blood  in  its  mucous  coat,  whether  under  the  form  of  mere  hyper- 
emia  (excess  of  blood),  or  an  actual  state  of  chronic  or  acute 
inflammation.  As  the  mere  evanescent  form  of  irritation  caused  by 
an  embarrassed  digestion  of  food  excessive  in  quantity  or  of  bad 
quality  tends  to  disturb  the  functions  of  the  liver,  and  at  length  to 
terminate  in  its  chronic  inflammation  and  enlargement,  so  far 
greater  must  be  the  evil  when  this  is  permanent,  as  a  degree  of 
complaint  in  the  mucous  membrane  such  as  I  have  described  would 
make  it.  "Facts  abound,"  says  Berard,  "to  prove  this  state  of 
stomach  to  be  the  real  origin  of  a  vast  majority  of  diseases  of  the 
liver."  We  need  not  refer  to  the  writings  of  Andral,  Louis,  Cru- 
veilhier,  Broussais,  Bonet,  or  a  host  of  others,  for  corroborative  testi- 
timony,  not  a  testimony  drawn  from  opinions,  but  from  the  rigid 
and  cold  observance  of  facts.  To  pass  in  review  the  symptoms 
which  mark  the  invasion  of  hepatic  disease,  will  almost  be  to  re- 
capitulate these  which  are  indicative  of  a  diseased  condition  of  the 
mucous  coat  of  the  stomach ;  for,  apart  from  the  physical  signs  fur- 
nished by  the  liver  itself,  we  have  hardly  any  other  symptoms  which 
are  not  proper  to  chronic  inflammation  of  the  latter  orcran. 

Pains  in  the  region  of  the  liver,  shooting  to  various  parts  of  the 
chest,  to  the  arms,  shoulders,  and  even  to  the  fingers,  are  commonly 
attendant  on  the  incipient  stages  of  disease  of  the  liver.  These 
pains  may  be  fixed  in  the  right  hypochondrium  or  in  the  epigas- 


80 


PARKER  ON  THE  STOMACH. 


trium ;  they  may  be  more  acute  in  the  shoulder,  in  the  neck, 
between  the  scapulae,  or  on  any  point  of  the  surface  of  the  chest ; 
they  may  be  lancinating  and  acute,  or  merely  a  dull,  heavy,  uneasy 
sensation.  In  persons  of  bilious  temperament  subject  to  that  form 
of  morbid  increase  in  the  formation  of  bile  which  Andral  has 
described  under  the  term  "hyperemie  bilieuse,"  these  pains,  in 
whatever  situation  they  may  be  seated,  are  constantly  recurring 
every  time  the  secretions  of  the  liver  become  deranged  or  unduly 
augmented ;  in  other  terms,  whenever  the  patient  becomes  bilious,  or 
is  troubled  with  nausea  or  diarrhoea.  At  these  times  the  patient 
frequently  experiences  a  dragging  or  sensation  of  weight  in  the 
region  of  the  liver,  which  coexists  with  the  pains  felt  in  various 
parts  of  the  thoracic  parietes. 

These  pains  bear  a  great  similarity  to  those  which  are  dependent 
upon  disease  of  the  stomach  alone,  where  no  affection  of  the 
liver  can  be  detected  or  is  supposed  to  be  in  existence.  I  have 
shown,  when  speaking  of  the  symptoms  of  inflammatory  irritation 
of  the  stomach,  that  pains  in  various  parts  of  the  chest  are  some- 
times the  chief  symptoms  by  which  such  affections  are  character- 
ised. Andral  mentions  the  case  of  a  man  who  died  from  cancer 
of  the  liver,  in  whom  the  pains  extended  down  the  arms  into  the 
hands.  I  have  now  a  lady  under  my  care  with  confirmed  chronic 
inflammation  of  the  stomach  ;  among  other  symptoms  she  has  con- 
stant pain  in  the  right  arm,  shooting  down  to  the  third  and  fourth 
fingers  of  the  hand,  the  sensibilities  of  which  are  considerably  im- 
paired. Another  lady,  who  has  the  physical  signs  of  incipient 
hypertrophy  of  the  liver,  and  who  is  for  weeks  in  perfect  health,  is 
subject  to  pains  in  the  shoulder  and  neck  so  acute,  whenever  the 
secretions  of  the  liver  become  impaired  or  unduly  augmented,  that 
she  is  totally  unable  to  move  the  head  from  side  to  side.  In  the 
case  of  a  second  lady,  of  about  twenty-two  years  of  age.  who  has 
laboured  under  the  symptoms  of  chronic  inflammation  of  the  sto- 
mach for  two  or  three  years,  but  who  has  never  suffered  from  bili- 
ary affections,  the  neck  will  become  fixed  in  the  same  way  when- 
ever the  stomach  affection  becomes  aggravated :  the  pain  and  stiff- 
ness of  the  neck  disappears  as  the  stomach  disease  gives  way.  The 
pains  which  have  been  described  by  Annesley,  Andral,  Ferrein, 
and  Portal,  as  symptomatic  of  disease  of  th£  liver,  and  which  coexist 
with  distinct  physical  signs  of  affections  of  this  organ,  are  also  found 
to  attend  the  various  forms  of  neuralgic  and  inflammatory  affections 
of  the  stomach,  and  are  commonly  met  with  in  such  diseases  when 
no  affection  of  the  liver,  ascertainable  by  the  usual  means  of  diag- 
nosis, can  possibly  be  shown  to  exist. 

Of  whatever  character  diseases  of  the  liver  may  be,  whether  they 
consist  in  changes  of  nutrition  merely,  in  enlargement  or  diminu- 
tion of  its  subsfance,  in  chronic  inflammation  or  its  consequences, 
no  symptoms  are  so  invariably  attendant  upon  the  progress  of  such 
diseases  as  those  which  are  connected  with  derangements  in  the 
functions  of  the  organs  of  digestion. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER.  81 

The  forms  of  disease  in  the  stomach  which  attend  the  incipient 
stages  of  disease  in  the  liver  are  of  various  kinds;  they  may  con- 
sist in  mere  hyperemia  of  the  rnncous  membrane  of  the  stomach, 
an  increase  of  blood  in  its  mucous  coat,  characterised  by  the  usual 
symptoms  of  an  attack  of  indigestion  of  the  inflammatory  kind,  the 
more  common  attendants  on  which  are  nausea,  flatulence,  disten- 
sion, tenderness  in  the  epigastrium,  loss  of  appetite,  a  loaded 
tongue,  with  occasional  vomiting,  and  a  bitter,  sour  or  clammy 
condition  of  the  mouth.  Sometimes  these  symptoms  are  occasioned 
by  what  is  termed  "a  bilious  attack,"  a  morbid  increase  in  the 
secretion  of  the  liver  without  any  assignable  cause;  the  impression 
of  which  secretion  on  the  mucous  surfaces  of  the  stomach  and  duo- 
denum occasions  the  derangements  observed  at  these  periods  in  the 
functions  of  the  stomach.  "Dans  plusieurs  circon  stances,  sans 
qinl  y  ait  hepatite  ou  hyperemie  du  foie,  sans  qu'il  y  ait  gaslro- 
enterite,  la  seule  maladie  qu'existe  est  une  augmentation  inexpli- 
cable dans  la  secretion  biliaire."1 

1  Andral,  Cours  de  Pathologic  Interne,  p.  215.  Bonet  (Monographic 
complete  des  Maladies  du  Foie)  admits  two  primitive  conditions  of  hepatic 
derangement,  the  result  of  irritation  in  the  stomach;  these  are,  a  morbid 
increase  in  the  secretion  of  the  liver,  not  amounting  to  an  inflammatory 
condition  ;  and  a  true  inflammatory  state,  the  symptoms  of  which  are  not 
well  marked;  on  account  of  its  slight  character.  The  first  state,  that  termed, 
in  common  language,  biliary  derangement,  is  one  in  which  the  natural 
function  of  the  liver  is  exalted,  under  the  influence  of  an  irritating  cause; 
and  though  the  symptoms  of  inflammation  are  frequently  absent,  they  are 
again,  in  a  great  number  of  instances,  present,  and  the  increased  secretion 
appears  dependent  upon  a  slightly  inflamed  condition  of  the  organ,  or  at 
least  upon  one  in  which  a  preternatural  fulness  of  blood  is  determined  to 
the  liver:  hence  the  name,  given  to  it  by  Andral,  of  "bilious  hyperemia." 
Sometimes  this  form  of  disease  is  unaccompanied  by  local  symptoms,  and 
is  only  evidenced  by  the  sympathetic  affections  it  produces;  in  other  in- 
stances the  symptoms  of  increased  determination  of  blood  are  present;  the 
tongue  is  dry  and  red,  the  skin  hot,  and  the  epigastrium  and  right  hypochon- 
drium  painful  and  tender  to  the  touch.  We  find  this  form  of  disease 
ushered  in  from  the  operation  of  two  classes  of  causes,  from  dietetic  errors 
and  from  moral  causes,  which,  first  affecting  the  stomach,  secondarily  act 
upon  the  liver.  In  these  circumstances,  whatever  be  the  nature  of  the  irri- 
tating cause  acting  upon  the  liver,  its  most  prominent  feature  is  an  inordidate 
secretion  of  bile:  and  hence  we  see  complete  jaundice  produced  frequently 
without  the  symptoms  of  inflammation  being  urgent,  or  even  well  or  strongly 
marked.  This  condition  of  the  liver  is  produced,  in  many  persons,  from  the 
most  trivial  exciting  cause  ;  from  a  slight  mental  impression,  or  from  errors 
in  diet  hardly  perceptible.  As  some  have  the  stomach  habitually  sick  (of 
which  I  have  given  instances  in  other  parts  of  this  work),  so  have  others  the 
liver  constantly  disposed  to  irritability  ;  and  hence  a  succession  of  irrita- 
tions, frequently  repeated,  at  length  induce  confirmed  hypertrophy  or  chronic 
inflammation.  In  some  persons  we  find  a  constant  state  of  indigestion  of 
the  inflammatory  kind,  the  tongue  always  coated  and  red,  the  epigastrium 
always  tender :  the  mucous  coat  of  the  stomach  is  here  habitually  in  a  con- 
gested state.  The  same  pathological  condition  exists  in  the  liver  in  tb» 
circumstances  of  continued  biliary  derangement.  "II  y  a  des  individus  chez 
qui  le  foie  est,  dans  1'etat  normal,  plus  volumineux,  plus  irritable,  plus 
susceptible  de  devenir  malade,  que  chez  les  autres  hommes.  La  gastro- 

park  6 


82  PARKER  ON  THE  STOMACH. 

These  attacks  of  stomach  disease  are  perpetually  occurring,  in 
some  persons  without  any  errors  or  excess  in  diet.  They  may 
continue  for  some  time,  even  for  years,  without  appearing  to  be  ac- 
companied by,  or  to  be  productive  of,  any  other  affection  ;  at 
length,  however,  pain  and  dragging,  with  weight  and  uneasiness 
in  the  right  hypochondrium,  are  complained  of,  and  on  carefully 
examining  the  region  of  the  liver  we  discover  a  distinct  tumour, 
tender  to  the  touch.  In  a  second  form,  the  affection  of  the  sto- 
mach which  accompanies  the  primary  symptoms  of  hepatic  disease 
assumes  more  distinctly  the  form  of  a  pure  gastritis,  or  gastro- 
enteritis. Instead  of  having  merely  nausea,  flatulence,  a  loaded 
tongue,  with  loss  of  appetite  and  confined  bowels,  we  have  violent 
vomiting,  with  considerable  fever,  a  dry  red  tongue,  a  sallow  coun- 
tenance, with  scanty  turbid  urine,  occasionally  diarrhoea  to  a  con- 
siderable extent,  with  pain  and  great  tenderness  in  the  epigastrium. 

These  symptoms  of  inflammation  of  the  stomach  attract  chiefly 
the  patient's  attention ;  the  slight  uneasiness  in  the  right  side  is 
lost  sight  of  in  the  more  acute  symptoms  which  have  been  added 
to  it. 

In  tracing  the  symptoms  of  incipient  disease  in  the  liver  which 
are  found  in  the  derangements  of  the  organs  of  digestion,  we  find 
every  variety  in  the  latter  affections,  from  mere  flatulence  to  peri- 
odical attacks  of  acute  gastritis.  To  give  instances  of  these 
varieties : — 

A  gentleman  had  complained  of  flatulence  for  many  years;  it 
distressed  him  exceedingly  after  taking  food.  No  hepatic  disease 
was  suspected,  but  he  has  now  a  distinct  enlargement  to  some 
extent  in  the  right  hypochondrium.  The  only  disturbance  of  his 
digestive  organs  is  the  distressing  flatulence,  which  still  continues. 

A  second  gentleman,  of  middle  age,  has  been  subject  to  flatulence, 
nausea,  and  great  fulness  after  food,  with  considerable  pain.  Of 
late  years  these  occasionally  terminate  in  acute  pain  in  the  epigas- 
tric region,  with  vomiting  and  purging  of  thin  frothy  matter,  re- 
sembling barm.  He  has  distinct  enlargement,  with  induration,  of 
the  liver. 

At  other  times  the  digestive  functions  are  constantly  disturbed, 
but  their  derangements  are  not  of  so  acute  a  character.  A  lady,  of 
middle  age,  who  has  suffered  from  the  symptoms  of  inflammatory 
indigestion  for  some  years,  and  who,  for  the  last  twelve  months, 
has  had  some  tenderness  in  the  right  hypochondrium.  is  seldom  a 
day  free  from  nausea,  and  once  or  twice  in  the  week  has  slight 
diarrhoea:  the  nausea  seldom  terminates  in  vomiting.  The  tongue 
is  generally  dry  and  slightly  coated,  with  the  edges  and  point  con- 
tracted and  vividly  red. 

entente  la  plus  legere  suffit  alors  pour  determiner  tant6t  une  secretion 
abondante  de  bile,  tantdt  une  veritable  hepatite  et  il  n'y  a  pas  de  raisoa 
pour  que  celle-ci,  une  fois  developpee,  ne  s'accroisse  indefiniment." — Bonet, 
Op.  cit.  p.  126. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER.  83 

The  varieties  in  the  affections  of  the  organs  of  digestion  which 
accompany  the  primary  forms  of  hepatic  diseases,  are  those  which 
depend  on  an  excited  state  of  the  vascular  system  of  the  stomach, 
which  may  be  reduced  to  three  divisions.  1st.  The  condition  cha- 
racterised by  mere  hyperemia;  2d.  A  state  of  chronic  or  sub-acute 
inflammation;  and  3d.  One  of  acute  inflammation.  In  persons 
addicted  to  the  excessive  and  continued  use  of  alcoholic  liquors, 
the  symptoms  of  hepatic  enlargement  and  inflammation  are  quickly 
ushered  in,  subsequent  to  an  attack  of  acute  inflammation  of  the 
mucous  membrane  of  the  stomach.  Again,  these  attacks  of  acute 
inflammation  sometimes  supervene  upon  a  long-continued  state  of 
chronic  disease. 

The  rapid  development  of  hepatic  diseases  under  the  use  of 
alcoholic  liquors  is  attributed  by  Andral,  in  some  instances,  to  the  sti- 
mulus which  the  spirit  gives  to  the  coats  of  the  veins  of  the  stomach, 
thence  exciting  in  them  a  pure  state  of  inflammation,  which  extends 
to  the  portal  system  and  to  its  ramifications  in  the  substance  of  the 
liver.  This  inflammation  of  the  veins  of  the  stomach  explains 
one  way  in  which  irritation  is  propagated  from  the  stomach  to  the 
liver,  and  the  manner  in  which  disease  in  one  organ  produces  a 
corresponding  morbid  state  in  another.  The  Clinique  Medicale 
contains  accounts  of  the  dissections  of  two  cases  in  which  this 
pathologic  state  was  found. 

In  examining  the  bodies  of  patients  who  have  died  from  gastric 
inflammations  and  their  consequences,  I  have  frequently  noticed 
the  immensely  distended  state  of  the  veins  of  the  sub-mucous  cellu- 
lar coat  of  the  stomach ;  they  are  sometimes  as  much  distended 
with  black,  grumous,  coagulated  blood,  as  though  they  had  been 
injected.  I  have  occasionally  noticed  the  vasa  brevia  in  this  state. 
All  cases  of  gastric  inflammation  which  terminate  fatally  are  not, 
however,  attended  by  this  condition  of  the  venous  system  of  the 
stomach. 

II. —  On  some  of  the  Symptoms  attendant  on  advanced  stages  of 
Diseases  of  the  Liver. 

The  rational  and  physical  signs  which  denote  the  existence  of 
hepatic  diseases,  consisting  in  hypertrophy  or  chronic  inflammation, 
may  continue  for  a  great  length  of  time  without  affecting  in  a  very 
serious  degree  the  constitution  of  the  patient,  if  he  be  tolerably 
guarded,  aware  of  the  true  character  of  his  disease,  and  the  nature 
of  its  complications  with  affections  of  the  digestive  organs.  The 
symptoms  which  accompany  the  more  advanced  stages  of  disease 
in  the  liver  are  drawn  as  much  from  the  affections  of  other  organs 
which,  during  the  long  continuance  of  disease,  have  become  asso- 
ciated with  the  primitive  affection,  as  from  the  liver  itself.  Whe- 
ther hypertrophy  and  chronic  inflammation  of  the  liver,  or  any  of 
its  component  parts,  be  diseases  consecutive  to,  and  produced  by, 
continued  irritation  of  the  stomach  and  duodenum  (an  opinion  to 


84  PARKER  ON  THE  STOMACH. 

which  facts  would  seem  to  lead  us)  or  not,  it  is  a  matter  of  certainty 
that  active  or  passive  hyperemia,  or  pure  gastritis  in  its  varied  forms, 
almost  always  complicates  disease  of  the  liver  in  its  more  advanced 
states.  The  inflammation  of  the  stomach  thus  set  up  produces  its 
own  influence  on  the  integrity  of  other  organs;  and  thus  the  latter 
stages  of  hepatic  diseases  are  accompanied  by  varied  morbid  condi- 
tions of  many  organs,  among  which  the  disease  of  the  liver  itself 
sometimes  becomes  secondary.  The  organs  which  chiefly  suffer, 
and  whose  affections  thus  accompany  and  add  to  the  difficulty  of 
the  treatment  in  such  cases,  are  the  stomach,  the  heart,  the  lungs, 
and  the  brain.  Sympathetic  diseases  in  -one  or  other  of  these 
organs  are  seldom  altogether  absent. 

III. — On  the  State  of  the  Digestive  Organs  in  the  latter  stages 
of  Disease  of  the  Liver. 

In  another  part  of  this  treatise,  we  have  shown  the  pathologic 
condition  of  the  stomach  and  intestines,  as  recognised  after  death, 
in  diseases  of  the  liver.  We  shall  now  pass  in  review  the  symp- 
toms of  diseased  conditions  of  the  digestive  organs  which  are 
observed,  in  the  progress  of  diseases  of  the  liver,  during  life.  In 
persons  perishing  from  hepatic  diseases,  it,  is  a  very  rare  thing  to 
find  the  stomach  and  intestines  free  from  lesion  in  some  variety  or 
another;  and  it  commonly  happens  that  pathologic  changes  of  the 
same  character  as  those  observed  in  the  liver  are  found,  at  the 
same  time,  in  the  stomach.  Thus,  as  far  as  the  subject  of  cancer 
merely  is  concerned,  Berard  has  proved,  from  his  researches,  that 
the  disease  commonly  co-exists  in  the  two  organs. 

The  most  common  affections  of  the  digestive  functions  observed 
during  life  in  diseases  of  the  liver  are,  attacks  of  acute  or  sub-acute 
gastritis.  Sometimes  these  attacks  supervene  upon  a  state  of  chro- 
nic gastritis  which  has  accompanied  the  affection  of  the  liver  from 
its  commencement.  Again,  we  find  that  violent  vomiting,  with 
fever,  and  a  vividly  red  and  contracted  tongue,  with  much  pain  and 
tenderness  in  the  epigastrium,  occur  from  slight  dietetic  errors,  and 
in  many  instances  without  such  errors  having  been  committed. 
After  these  attacks  have  been  subdued  by  appropriate  treatment,  we 
observe  a  constant  disposition  to  their  recurrence.  In  these  in- 
stances the  stomach  may  suffer  secondarily  from  that  general  febrile 
state  induced  in  the  system  by  the  disease  of  the  liver,  or  from  the 
sympathies  existing  between  the  two  organs ;  or,  again,  the  gastritis 
maybe  a  mere  exaltation  of  that  vascular  irritation  which  primitively 
existed  in  the  stomach,  and  from  which  the  hepatic  disease  origi- 
nally sprung. 

IV. — On  the  Symptoms  observed  in  Disturbances  of  the 
Circulation. 

The  circulation  and  its  central  organ,  the  heart,  do  not,  in  all 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER.  85 

cases  of  confirmed  disease  of  the  liver,  afford  any  marked  symp- 
toms of  peculiar  disturbance  of  their  functions,  except  that  mere 
increase  of  frequency  in  pulsation  which  is  observed  more  or  less 
in  all  feverish  or  inflammatory  diseases.  There  are,  however,  cer- 
tain cases  in  which  great  peculiarities  are  observed  in  the  action  of 
the  heart  during  the  course  of  hepatic,  diseases,  which  it  becomes 
necessary  to  notice.  These  disturbances  may  vary  from  an  in- 
creased and  tumultuous  impulse  of  the  heart  to  great  irregularities 
in  its  action,  which  would  almost  lead  to  the  supposition  that  the 
organ  itself  was  diseased.  Occasionally  the  pulse  presents  a  great 
degree  of  sharpness,  and  the  stethoscope  applied  over  the  heart 
detects  an  unusual  force  in  its  impulse.  In  one  case  of  this  kind, 
which  commenced  with  a  series  of  dyspeptic  symptoms  two  years 
before  its  fatal  termination,  the  pulse  offered  a  peculiar  sharpness, 
and  auscultation  detected  a  strong,  tumultuous  impulse  of  the  heart; 
the  pulse  never  intermitted,  although  the  two  sounds  of  the  heart 
were  lost  in  one  strong  pulsation.  This  patient  had  general  adhe- 
sion of  the  pericardium,  with  softening  of  the  substance  of  the 
heart;  abscess  of  the  liver,  an  aggravated  state  of  gastritis,  with  a 
highly  congested  state  of  the  veins  of  the  sub-mucous  coat  of  the 
stomach,  which  were  filled  with  black  grumous  blood.1  This  pa- 
tient had  ascites.  I  have  at  the  present  moment  under  my  care  a 
gentleman  with  an  immense  hepatic  tumour,  accompanied  by 
ascites.  The  pulse  offers  the  same  peculiar  sharpness,  arid  the 
action  of  the  heart  is  inordinately  strong.  In  this  person  there  are 
periodical  attacks  of  acute  gastritis  or  gastro-enteritis ;  for  the 
vomiting  is  frequently  accompanied  by  severe  diarrhoea,  and  the 
stools  are  sometimes  of  a  bloody  cast.  During  the  prevalence  of 
the  gastric  affection,  the  symptoms  of  disturbance  in  the  action  of 
the  heart  were  always  much  more  acute,  occasionally  to  the  extent 
of  requiring  local  abstraction  of  blood  from  the  region  of  the  heart 
in  order  to  subdue  them.  In  the  section  on  the  influence  of  the 
stomach  upon  the  heart,  I  have  shown  that  there  is  great  reason  to 
suppose  that,  in  many  instances,  organic  changes  in  the  heart  are 
the  result  of  continued  gastric  derangement.  It  is  certain,  as 
Broussais  has  remarked,  that  a  state  of  softening  of  the  heart  is 
commonly  the  result  of  prolonged  gastro-enteric  disease,  in  which 
the  liver  and  the  spleen  frequently  offer  (he  same  pathologic  change. 
Portal  has  shown  how  frequently  affections  of  the  heart  are  com- 
plicated with  diseases  of  the  liver.2 

1  Adhesions  of  the  pericardium  with  the  substance  of  the  heart  are  not 
unusually  found  on  dissection  after  death  from  diseases  of  the  liver,  or  of 
this  organ  and  the  stomach  conjointly.  Among  others,  the  case  of  a  fisher- 
man of  Venice  related  by  Morgagni  (Letter  5,  Obs.  19),  is  worthy  of  atten- 
tion. This  man  had  some  old-standing  dyspeptic  symptoms,  during  an  ag- 
gravated condition  of  which  he  died  suddenly.  On  examination,  the  sto- 
mach, intestines,  and  liver,  presented  evidences  of  inflammatory  disease; 
the  pericardium  was  every  where  adherent  to  the  heart. 

*"De  1'etat  du  Foie  apres  les  Palpitations,  &c.,"  Art.  xii.  Du  Traite  des 
Maladies  du  Foie. 


86  PARKER  ON  THE  STOMACH. 

In  several  instances  of  hepatic  disease,  however,  the  circulation 
in  so  much  embarrassed,  the  pulse  so  unsteady,  and  the  action  of  the 
heart  so  irregular,  that,  when  those  symptoms  are  observed  to  co- 
exist with  anasarca  or  asciles.  we  are  sometimes  led  to  attribute 
them  to  valvular  disease  of  the  heart,  independent  of  any  other 
affection.  An  old  lady,  aged  sixty,  came  under  my  care,  in  the 
latter  part  of  last  year,  with  all  the  symptoms  of  an  organic  affec- 
tion of  the  heart.  The  pulse  at  the  wrist  was  merely  a  tremulous 
motion  of  the  artery,  hardly  to  be  called  pulsation.  Auscultation 
ot  the  heart  detected  a  tumultuous  undulation,  but  no  distinct  rhythm 
or  sound.  The  face  was  livid  and  swollen,  and  the  legs  anasar- 
cous;  all  food  occasioned  great  pain,  and  was  immediately  rejected 
by  vomiting;  the  epigastric  and  right  hypochondriac  regions  highly 
sensible  to  pressure.  On  examination  after  death  the  liver  was 
found  greatly  hypertrophied,  pale,  and  hard;  the  stomach  one  mass 
of  inflammation,  its  submucous  veins  much  dilated,  and  full  of  dark 
coagulated  blood;  the  heart  healthy,  as  regards  the  disposition  of 
its  investing  and  lining  membranes  and  the  condition  of  its  valves; 
its  substance  was  very  pale,  and  soft. 

In  addition  to  any  organic  changes  which  may  exist  in  the  heart, 
and  which  may  complicate  diseases  of  the  liver,  we  may  observe 
occasionally  a  most  irregular  condition  of  the  circulation  existing 
without  any  organic  change  in  the  heart  itself.  In  the  section  on 
the  influence  of  the  stomach  upon  the  heart,  I  have  quoted  a  case 
from  Cruveilhier,1  in  which  the  circulation  was  so  unsteady,  and  the 
signs  afforded  by  auscultation  so  seemingly  certain,  that  an  organic 
change  was  suspected  in  the  heart.  On  examination  after  death 
the  heart  was  found  perfectly  healthy,  but  cancerous  disease  existed 
both  in  the  stomach  and  liver.  I  have  there  also  adduced  another 
case,  from  my  own  practice,  in  which  great  irregularity  of  the  cir- 
culation was  present;  but  dissection  showed  nothing  but  an  en- 
larged and  hard  liver,  with  inflammatory  disease  of  the  stomach. 
Although  these  derangements  in  the  heart's  action  are  met  with 
daring  the  progress  of  diseases  of  the  liver,  still  they  are  also  found 
co-existing  with  various  forms  of  disease  of  the  stomach  when  the 
liver  is  perfectly  healthy,  or  presents  so  little  alteration  that  it  cannot 
be  supposed  to  influence  materially  the  condition  of  the  heart. 

V. — On  the  Symptoms  observed  in  Disturbances  of  the  Organs 

of  Respiration. 

During  the  progress  of  hepatic  diseases,  we  commonly  observe 
that  the  respiratory  organs  deviate  more  or  less  from  their  natural 
state,  whether  these  deviations  are  observed  merely  in  functional 
derangements,  such  as  hurried  breathing  or  spasmodic  cough,  or  in 
an  actually  inflamed  condition  of  the  lung,  the  pleura,  or  the  bron- 
chice.  These  disturbances  result  from  the  volume  of  the  liver 

'Anatoinie  Pathologique  du  Corps  Humaine. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER. 

pressing  upward  the  lungs  and  contracting  the  cavity  of  the  chest, 
or  from  irritation  propagated  from  the  liver  to  the  lung,  independent 
of  an  increased,  bulk  in  the  former.  If  we  examine  the  cases  de- 
tailed by  M.  de  Larroque,1  we  shall  find  many  examples  of  affections 
of  the  chest  thus  produced  during  the  progress  of  hepatic  diseases. 
The  affections  of  the  organs  of  respiration  which  accompany  he- 
patic diseases  are  of  various  kinds ;  they  may  consist  merely  in  a 
short  dry  cough,  in  continued  fits  of  coughing  without  expectora- 
tion, or  in  cough  followed  by  expectoration  of  frothy,  mucous, 
purulent,  or  sanguineous  matter. 

A  lady  of  middle  age,  the  mother  of  one  child,  had  been  affected 
with  constant  dry  cough,  for  some  months,  during  the  continuance 
of  which  she  had  emaciated  much.  The  most  repeated  examina- 
tion of  the  chest  convinced  me  that  all  the  organs  contained  in  it 
were  healthy.  The  conjunctivee  had  a  yellow  tinge,  the  counte- 
nance was  sallow,  the  tongue  clean,  but  red,  its  papillae  injected 
and  elevated.  This  lady  had  been  subject  to  dyspeptic  symptoms, 
with  occasional  vomiting,  for  some  time.  On  examining  the  ab- 
domen, a  distinct  tumefaction  was  observed  in  the  hepatic  region, 
extending  downwards  to  some  distance;  it  was  tender  to  the  touch ; 
the  epigastric  region  also  hot  and  tender,  and  the  seat  of  strong 
pulsation.  The  cough  ceased  from  the  application  of  several  relays 
of  leeches  over  the  stomach  and  liver,  and  the  patient  recovered 
her  usual  health. 

A  second  lady,  whose  case  is  mentioned  by  Larroque,2  had  a  severe 
attack  of  gastritis.  After  the  acute  symptoms  had  disappeared,  there 
remained  daily  vomiting,  difficult  digestion  accompanied  by  flatu- 
lence, obstinate  constipation,  a  dry,  short  constant  cough  with  con- 
siderable difficulty  of  breathing,  augmented  to  a  sense  of  suffoca- 
tion by  taking  food.  On  examining  the  abdomen,  three  months 
after  the  appearance  of  these  symptoms,  a  considerable  hepatic 
tumour  was  discovered,  extending  into  the  left  hypochondrium, 
and  downwards  below  the  umbilicus.  The  patient  complained 
constantly  of  her  stomach;  the  cough  seemed  to  arise  from  that 
point,  or  rather  the  irritation  producing  it.  Every  species  of  aliment, 
even  simple  gruel  or  broth,  increased  the  uneasiness,  the  cough, 
and  hurried  breathing.  This  lady  recovered  under  the  use  of 
bleeding  and  mercurial  frictions. 

These  two  cases  are  examples  of  diseases  of  the  liver  accompa- 
nied by  functional  derangements  of  the  organs  of  respiration. 
Both  the  cases,  however,  appear  to  have  commenced  in  affections 
of  the  stomach.  The  dyspeptic  symptoms,  depending  evidently  on 
inflammatory  irritation  of  the  mucous  membrane  of  this  organ, 
were  severe  during  the  whole  progress  of  disease  in  both  cases,  and 
the  symptoms  observed  in  the  disordered  condition  of  the  organs 

1  De  Q,uelques  Maladies  Abdominales  qui  simulent,  provoquent  ou  entre- 
tiennent,  des  Maladies  de  Poitrine. 
»Op.  cit.,  Obs.  4,  p.  482. 


88  PARKER  ON  THE  STOMACH. 

of  respiration  appear  to  have  depended  as  much  upon  the  latter 
affection  as  upon  the  state  of  the  liver.  This  will  be  more  evident 
by  referring  to  the  chapter  "On  the  Influence  of  the  Stomach  on 
the  Respiratory  Organs." 

In  some  instances  the  symptoms  observed  in  the  chest,  during 
the  course  of  hepatic  diseases,  amount  to  actual  organic  lesions 
observed  in  an  inflammatory  condition  of  one  or  other  of  its  con- 
tained organs.  "A  gentleman,  forty-five  years  of  age,  accustomed 
to  indulgence  in  the  pleasures  of  the  table,  had  been  subject  for 
some  time  to  dyspeptic  symptoms,  which  were  shown  in  severe 
attacks  of  colic,  preceeded  by  obstinate  constipation,  and  accom- 
panied by  a  jaundiced  and  dry  condition  of  the  skin,  with  occa- 
sional pains  in  the  right  hypochondriac  and  epigastric  regions.  To 
these  symptoms  were  added,  some  time  subsequently,  cough,  with 
difficult  respiration  and  expectoration  of  mucous,  yellowish  or  gray 
sputa  of  bitter  taste,  sometimes  streaked  with  blood ;  at  the  same 
time  the  tongue  was  coated,  red  at  its  point  and  edges,  and  the 
mucous  membrane  of  the  mouth  and  fauces  inflamed,  and  a  jaun- 
diced tint  upon  the  skin.  The  expectoration  amounted  to  a  pint 
in  the  course  of  the  day.  He  had,  also,  severe  bilious  diarrhoea. 
The  examination  at  this  period  of  his  disease  detected  the  existence 
of  a  large  hepatic  tumour.  Mucilaginous  arid  anodyne  medicines, 
with  blisters  upon  the  chest,  were  productive  of  no  benefit  in  the 
alleviation  of  these  symptoms;  the  uneasiness  in  the  regions  of  the 
stomach  and  liver,  with  the  fulness  of  the  pulse,  led  to  the  application 
of  leeches  to  the  anus.  After  this  the  expectoration  ceased  to  be 
bloody,  and  the  diarrhoea  diminished,  but  the  pains  in  the  regions 
of  the  stomach  and  liver  still  continued.  Some  time  after,  the  ex- 
pectoration suddenly  ceased,  and  the  patient  sunk  with  the  symp- 
toms of  effusion  into  the  chest.  On  examination  after  death,  the 
bag  of  the  right  pleura  was  found  to  contain  about  a  pint  of  bloody 
serum.  The  inferior  lobe  of  this  lung  was  adherent  to  the  dia- 
phragm, through  which  it  communicated  with  a  large  abscess  which 
occupied  nearly  the  whole  substance  of  the  liver,  part  of  the  walls 
of  the  abscess  being  formed  by  a  portion  of  the  lung  itself.  The 
mucous  membrane  of  the  stomach  and  colon  were  both  in  an  in- 
flamed state."1 

In  examining  the  history  of  this  case,  we  observe  it  to  have 
commenced  in  symptoms  of  gastric  disturbance,  evidently  of  the 
inflammatory  kind,  thence  progressing  to  the  liver,  and  ultimately 
to  the  lungs.  The  progress  of  the  symptoms  is  explained  by  the 
pathologic  changes  after  death.  It  is  thus  that  we  often  find  dis- 
eases, which  commence  in  mere  symptoms  of  gastric  derangement, 
terminate,  in  after-life,  in  others  whose  more  prominent  features 
mark  the  original  affection  to  which  they  owe  their  origin. 

Bronchial  affections  frequently  make  their  appearance  during  an 
aggravated  state  of  the  symptoms  of  diseases  of  the  liver,  and  the 

'Portal,  Memoires  sur  plusieurs  Maladies,  t.  iii. 


INFLUENCE  OP  ITS  MORBID  STATES  ON  THE  LIVER.  89 

affections  of  the  stomach  which  accompany  them,  and  disappear 
when  these  symptoms  are  subdued  by  appropriate  treatment.  A 
gentleman,  a  free  liver,  indulging  in  the  pleasures  of  the  table,  had 
suffered  from  symptoms  of  gastritis  for  many  months,  accompany- 
ing which  he  had  a  large  hepatic  tumour.  The  skin  was  jaundiced, 
the  tongue  intensely  red,  the  epigastric  region  hot  and  tender,  and 
the  action  of  the  heart  inordinately  strong.  After  a  day  of  more 
than  usual  indulgence  severe  vomiting  set  in,  with  diarrhoea,  cough, 
hurried  breathing,  and  expectoration  of  muco-purulent  fluid,  which 
increased  till  he  spat  from  two  to  three  pints  in  the  course  of  the 
day.  Leeches  were  applied  freely  over  the  hepatic  and  epigastric 
regions,  and  occasional  doses  of  blue  pill  and  opium  were  given 
with  the  hydrocyanic  acid.  By  this  treatment  the  inflammatory 
symptoms  were  subdued,  and  with  them  the  cough  and  expectora- 
tion also  disappeared.  It  is  an  established  fact  that  gastric  irrita- 
tion has  the  power  of  producing  disease  of  the  liver  ;  and  it  is  also 
certain  that  the  irritation  produced  in  the  latter  organ  is  frequently 
propagated  to  the  chest,  and  is  productive  of  many  of  its  diseases, 
as  pleurisy,  pneumonia,  and  bronchitis;  so  that  in  many  instances, 
we  observe  diseases  of  the  liver,  stomach,  and  lungs,  coexisting  as 
in  the  two  former  cases. 

In  the  midst  of  many  diseased  organs,  it  is  of  importance  to  trace 
the  commencement  of  the  affection,  and  determine  the  relative  im- 
portance of  each  in  the  mass  of  mischief :  where  the  stomach  pre- 
sents symptoms  of  lesion,  this  organ  always  demands  particular 
attention.  Although,  in  the  forms  of  disease  of  wrricji  we  are 
speaking,  the  stomach  is  often  the  source  of  mischief,  still  there  are 
other  complications  of  diseases  of  the  liver  with  those  of  the  organs 
of  respiration  in  which  the  stomach  is  found  perfectly  healthy.  In 
many  of  these  instances  the  inflammation  commences  in  the  lungs 
or  their  investing  membrane,  and  is  thence  propagated  to  the  liver. 
I  have  seen  two  instances  of  pneumonia  terminating  in  abscess 
which  have  commenced  in  the  inferior  lobe  of  the  right  lung,  and 
have  ultimately  involved  the  liver  in  the  disease.  In  both  these 
cases  the  stomach  was  healthy.  Andral1  has  recorded  another  in- 
stance of  this  mode  of  extension  of  disease  from  the  lung  to  the  liver. 
Regnault2  has  also  noted  several  instances  of  pleurisy  producing 
hepatitis. 

PARTICULAR  CASES. 

CASE  1. — Symptoms  of  indigestion  of  the  inflammatory  kind  for  twenty- 
five  years. — Sub-acute  inflammation  of  the  stomach. — Hypertrophy,  with 
sanguineous  congestion  of  the  liver. 

In  June,  1834, 1  was  requested  to  visit  Mrs.  C — .  She  was  a 
delicate  woman,  and  had  laboured  under  severe  dyspeptic  symptoms 

JClinique  Medicale,  tome  iv.,  Obs.  23. 

2Memoires  sur  les  alterations,  et  1'influence  du  Foie  dans  plusieurs  Mala- 
dies, et  sur  les  moyens  curatifs  qu'elles  reclament.  Par  P.  G.  R.  Regnault. 


90  PARKER  ON  THE  STOMACH. 

for  twenty-five  years.  During  this  period  she  had  almost  constantly 
pain  and  tenderness  in  the  epigastrium,  with  occasional  vomiting 
of  food. 

June  24,  1834. — The  patient  so  weak  as  to  be  unable  to  sit  up 
in  bed.  General  uneasiness  of  the  belly,  which  is  tender  on  pres- 
sure in  the  right  hypochondriac  and  epigastric  regions;  sensibility 
greatest  in  the  epigastric.  All  food  is  constantly  rejected;  occa- 
sionally blood  is  thrown  up.  Bowels  obstinately  constipated.  Ab- 
domen full,  but  not  tympanitic.  Pulse  small,  sharp,  easily  com- 
pressed, but  steady,  and  at  ninety-five.  Tongue  dry  and  shining, 
and  of  a  reddish-brown  colour.  Urine  scanty;  has  not  been 
voided  till  to-day  for  fifty  hours.  No  cough  or  hurried  breathing. 
Had  epistaxis  two  days  since;  it  has  returned  again  to-day. 

As  the  patient  appeared  to  be  sinking,  she  was  ordered  merely 
two  grains  of  calomel  and  half  a  grain  of  opium  to  allay  her  dis- 
tressing sickness,  and  to  have  a  domestic  enema. 

June  26. — Gradually  sinking;  voided  some  blood  by  stool,  and 
died  in  the  evening.  In  addition  to  the  symptoms  above  detailed, 
I  learned,  on  to-day's  visit,  that  the  stools  for  some  days  past  had 
been  of  a  chalky  whiteness.  There  had  been  occasional  pain  in  the 
right  hypochondrium,  which  region  was  hard  and  full.  The 
greatest  and  most  constant  pain  was  always  referred  by  the  patient 
to  the  left  part  of  the  epigastrium. 

Post-mortem  examination,  thirty-six  hours  after  death. — Hody 
not  much  emaciated,  of  a  deep-jaundiced  colour.  The  liver  ex- 
tended downwards  nearly  to  the  pelvis;  upwards  it  was  much  en- 
larged, compressing  the  right  lung.  It  extended  across  the  epigas- 
trium, and  left  hypochondrium,  intimately  adhering,  by  its  peritoneal 
coat,  to  the  spleen.  It  adhered  also  to  the  transverse  arch  of  the 
colon.  The  gall-bladder  was  amalgamated,  by  thickened  adhesions, 
to  the  liver.  It  contained  two  large  gall-stones,  as  large  as  nut- 
megs; and  a  third,  of  the  same  size,  was  found  in  its  duct.  The 
internal  structure  of  the  liver  was  very  dark;  a  good  deal  of  dark- 
coloured  blood  exuded  when  it  was  cut  into.  The  thoracic  viscera 
presented  no  pathologic  state  worthy  of  note. 

The  cardiac  portion  of  the  stomach  was  highly  vascular,  studded 
with  red  points,  and  patches  of  an  arborescent  appearance,  intensely 
red.  The  pyloric  portion  was  one  mass  of  pink  injection,  covered 
by  a  thick  layer  of  bloody  mucus.  The  mucous  surfaces  of  the 
duodenum  and  small  and  large  intestines  were  stained  with  bile, 
but  otherwise  healthy:  the  bladder  full  of  dark-brown  urine. 

Remarks. — On  looking  back  over  the  history  of  this  case,  we 
find  the  subject  of  it  to  have  been  troubled  with  painful  and  labori- 
ous digestion  for  twenty-five  years,  which  symptoms  were,  in  the 
onset,  probably  dependent  upon  a  congested  or  active  hyperemic 
state  of  the  mucous  membrane  of  the  stomach.  To  relieve  herself 
she  occasionally  drank  gin  or  brandy,  and  lately  had  become  a  great 
taker  of  laudanum.  Under  this  continued  gastric  irritation,  there 
is  no  doubt  that  the  enlargement  and  chronic  inflammation  observed 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER. 


91 


in  the  liver  and  its  membranes  commenced,  and  the  disease 
of  the  stomach  assumed  the  form  of  confirmed  chronic  gas- 
tritis. For  the  last  seven  months  of  the  patient's  life  we  find 
her  constantly  vomiting  food,  and  often  blood:  this  marks  the  in- 
vasion of  a  more  acute  form  of  gastritis.  We  find,  in  conjunction 
with  the  disease  of  the  stomach,  the  liver  hypertrophied  to  a  great 
extent;  the  sequelae  of  chronic  inflammation  in  its  peritoneal  coat, 
and  concretions  in  the  gall-bladder:  these  evidently  the  consequence 
of  some  change  in  the  character  of  the  bile,  dependent  upon  dis- 
ease in  the  organ  secreting  it.  The  spontaneous  occurrence  of 
epistaxis  in  this  case  is  worthy  of  remark,  as  hemorrhage  of  this 
character  frequently  occurs  during  protracted  inflammatory  diseases 
of  the  gastro-enteric  mucous  surfaces. 

We  observe  in  this  case  a  mere  enlargement  of  the  liver,  without 
any  change  in  the  density  of  its  substance.  These  conditions  of 
hypertrophy  may  also  be  attended  with  an  increase  or  decrease  of 
the  density  of  the  substance  of  the  liver,  under  the  form  of  indura- 
tion or  softening.  On  the  former  of  these  two  states  ascites  is 
commonly  attendant,  though  it  does  not  exist  in  every  instance. 
The  attentive  examination  of  the  history  of  this  case  brings  us  to 
the*  conclusion  that  the  disease  of  the  liver  was,  in  this  instance, 
produced  under  the  influence  of  the  gastric  irritation,  which  deter- 
mined to  all  the  organs  concerned  in  digestion  an  increased  quan- 
tity of  blood.  The  details  of  this  case  very  much  resemble  one  in 
the  Clinique  Medicale,  in  which  the  patient  sunk  from  hypertrophy 
of  the  liver  six  years  after  the  use  of  extremely  irritating  medicines, 
which  had  disturbed  his  digestive  powers  to  an  extent  which  they 
had  never  recovered.  In  this  instance,  Andral  considers  that  the 
enlargement  of  the  liver  was  consecutive  to  the  inflammation  of 
the  stomach,  and  the  result  of  an  inflammatory  process.1  The 
general  principles  of  pathology  likewise  recognise  increased  deter- 
mination of  blood,  under  the  influence  of  an  irritating  cause,  as  one 
source  of  the  hypertrophy  of  organs.  "Some  enlargements  of  this 
character  are  owing  to  chronic  determination  of  blood.  In  such 
cases  the  hypertrophy  is  sometimes  confined  to  the  tissue  which 
was  primarily  irritated  or  congested,  whilst,  again,  after  the  tissue 
originally  affected  has  returned  to  its  natural  healthy  condition,  the 
adjacent  tissues  (or  organs)  retain  a  chronic  form  of  disease,  and 
become  hypertrophied."2  We  may  conceive  of  hypertrophy  of  the 
liver,  in  this  form  of  disease,  taking  place  much  as  that  of  the  heart 
does  from  inflammation  of  its  endocarde  or  lining  membrane.  In 
the  same  manner  we  daily  observe  true  hypertrophy  of  the  sub- 
maxillary  chain  of  lymphatic  glands  to  take  place  from  chronic 
inflammation,  or  ulceration  existing  about  the  lips  or  lower  parts  of 
the  face.  I  do  not  know  an  instance  where  this  species  of  hyper- 

1  Clinique  Medicale,  by  Spillan,  Case  6,  p.  940. 

3  A  Treatise  on  Pathological  Anatomy,  by  G.  Andral,  translated  by  Drs. 
Townsend  and  West,  tome  i.,  p.  224. 


92  PARKER  ON  THE  STOMACH. 

trophy,  coinciding  with  gastritis  or  gastro-duodenitis,  is  not  owing  to 
a  chronic  form  of  hyperemia  or  inflammation.  In  some  instances  we 
find  purulent  collections  in  the  centre  of  livers  thus  hypertrophied, 
or  some  parts  of  their  structure  completely  disorganised.  Generally, 
however,  where  this  organ  is  hypertrophied  to  a  great  extent,  it  is 
harder  and  paler  in  its  structure  than  in  its  healthy  state.  Where 
softening  and  abscess  are  the  chief  lesions  the  liver  is  not  so  much 
enlarged.  A  less  acute  degree  of  morbid  action  than  that  accom- 
panying the  second  form  of  disease  appears  to  be  present  in  the 
first. 

In  some  instances,  affections  of  the  liver  are  developed  quickly 
under  the  influence  of  an  acute  or  subacute  attack  of  gastric  inflam- 
mation, instead  of  being  produced,  as  in  the  preceding  cases,  by 
chronic  irritation  of  the  digestive  organs. 

CASE  2.' — Subacute  inflammation  of  the  stomach  and  bowels  succeeding  the 
sudden  disappearance  of  a  cutaneous  eruption — Sudden  appearance  of  dis- 
ease of  the  liver — Tumour  in  the  right  hypochondrium. 

A  sempstress,  aged  16,  caused  to  disappear  suddenly  an  eruption 
with  which  she  had  been  troubled  for  some  time.  A  few  days 
afterwards  a  slight  diarrhoea  made  its  appearance,  accompanied  by 
pains  in  the  stomach,  total  loss  of  appetite,  and  constant  disposition 
to  vomit.  She  was  treated  by  emetics.  The  pains  in  the  stomach 
and  the  diarrhoea  continued,  the  sensibility  of  the  epigastric  region 
increased,  and  the  distaste  for  food  was  carried  to  such  an  extent 
that  the  mere  appearance  of  it  produced  an  attempt  to  vomit.  The 
menses  being  suppressed,  she  was  now  treated  by  emmenagogues 
for  three  months.  Under  this  plan  she  still  continued  to  get  worse; 
emaciation  proceeded  rapidly,  a  jaundiced  tint  appeared  upon  the 
skin,  the  nausea  terminated  in  periodical  vomiting ;  whilst  at  the 
same  time  a  regular  paroxysm  of  fever  came  on  every  evening. 
Being  examined  by  M.  Bonet  at  this  period  of  her  complaint,  he 
ascertained  that,  in  addition  to  the  stomach  affection,  there  existed 
extensive  disease  of  the  liver.  This  viscus  was  so  large  that  it 
extended  three  or  four  fingers'  breadth  below  the  false  ribs,  and 
formed  a  considerable  tumour  in  the  right  hypochondrium.  The 
patient  sunk  into  an  extreme  degree  of  marasmus.  The  body  was 
not  examined. 

Remarks. — Although,  in  this  case,  the  body  was  not  examined 
after  death,  the  physical  signs  of  hepatic  disease  succeeding  to  the 
gastric  render  it  a  matter  of  certainty  that  the  irritation  which  first 
appeared  in  the  stomach  and  bowels  ultimately  extended  to  the 
liver,  under  the  influence  of  treatment  calculated  rather  to  exaspe- 
rate than  to  allay  the  primitive  disease.  As  these  cases  show  that 
irritation  of  the  stomach,  whether  acute  or  chronic,  may  ultimately 
extend  to  the  liver  and  produce  disease  in  that  organ,  and  as  the 

1  Bonet,  Monographic  complete  sur  les  Maladies  du  Foie,  p.  107. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER.  93 

history  of  the  last  case  exhibits  more  particularly  the  fatal  termi- 
nation of  such  cases  accelerated  under  the  influence  of  a  treatment 
calculated  to  keep  up  or  increase  the  irritation  already  existing  in 
the  stomach,  so  the  details  of  the  following  case  will  show  that  an 
appropriate  plan  of  treatment,  adopted  with  a  view  to  the  removal 
of  gastric  or  gastro-enteric  inflammation,  co-existing  with  hepatic 
disease,  will  arrest  the  progress  of  the  latter,  even  when  it  has  pro- 
ceeded to  a  great  extent. 

CASE  3.— Symptoms  of  chronic  gastritis  of  long  standing  occasionally 
becoming  acute — Scirrhous  hardness  and  great  enlargement  of  the  liver — 
Great  relief  afforded  by  exclusive  attention  to  the  stomach  disease. 

I  have  been  occasionally  consulted  by  a  gentleman,  during  the  last 
three  years,  for  dyspeptic  symptoms,  attended  with  loss  of  appetite, 
pain  and  distension  after  meals,  with  much  flatulence  and  occasional 
vomiting.  I  was  sent  for  suddenly  one  evening,  and  found  him 
labouring  under  an  attack  of  acute  gastritis.  He  had  constant 
vomiting  of  sour  and  bilious  fluids,  with  purging  of  thin  white- 
coloured  matter.  Acute  epigastric  pain,  increased  to  agony  by 
pressure.  Rapid,  thin,  unsteady  pulse,  cold  skin,  and  an  intensely 
red  tongue.  The  constant  recurrence  of  these  symptoms  without 
any  assignable  cause,  led  rne  to  examine  the  hepatic  region  very 
carefully.  I  found  it  dull  on  percussion  for  a  very  considerable 
extent  downwards,  nearly  to  the  ilium,  extending  across  the  epi- 
gastrium into  the  left  hypochondrium,  and  nearly  to  the  umbilicus. 
This  space  was  occupied  by  a  resisting  tumour,  which  could  be 
defined  with  great  ease;  it  had  a  scirrhous  hardness,  and  an 
uneven  tuberous  surface,  presenting  to  manual  examination  that 
pathologic  state  of  the  liver  termed  by  Cruveilhier  "  Cancer  by  dis- 
seminated masses :  hard  variety."1  After  the  subsidence  of  the 
acute  attack,  the  epigastrium  continued  sensible  to  pressure  when 
the  patient  was  placed  in  the  recumbent  position  ;  but  no  pain  was 
experienced  on  hard  pressure  in  this  region  when  he  leaned  for- 
ward. Considerable  pain  followed  the  taking  of  food,  accompanied 
by  fulness,  nausea,  and  distressing  flatulence.  The  tongue  coated 
posteriorly,  vividly  red  at  the  point,  edges,  and  on  the  uncoated 
surface;  papillae  much  devoloped.  There  was  no  cough,  and  the 
pulse  was  soft,  steady,  and  hardly  at  all  accelerated.  The  patient 
was  put  upon  a  strict  milk  and  farinaceous  diet,  relays  of  leeches  in 
small  numbers,  proportionate  to  the  powers  of  the  constitution, 
•were  applied  every  two  days,  and  small  doses  of  blue  pill  and  rhu- 
barb, with  the  ponderous  carbonate  of  magnesia,  combined  occa- 
sionally with  bitters  and  aloetics,  were  administered  to  obviate  the 
costiveness,  which  was  obstinate. 

This  plan  was  continued  for  four  months,  with  hardly  any  vari- 

1  "  Cancer  au  foie  par  masses  disseminees ;  variete  dure." — Cruveilhier, 
Anatomic  Pathologique,  12me.  livraison,  p.  8. 


94  PARKER  ON  THE  STOMACH. 

ation.  At  the  end  of  this  period  all  the  heat  and  pain  in  the  epi- 
gastrium had  disappeared,  the  emaciation,  which  had  commenced, 
was  arrested.  The  fulness  of  the  bowels,  which  at  one  time  I 
feared  would  have  terminated  in  ascites,  was  reduced;  they  became 
soft,  free  from  uneasiness,  and  acted  freely  without  medicine.  The 
appetite  also  was  much  improved.  I  recommended  that  the  diet 
should  be  adhered  to,  and  the  bowels  regulated  occasionally  by  in- 
jections of  warm  water,  with  the  addition  of  a  little  castor  oil,  if 
necessary,  being  unwilling  to  distress  the  stomach  by  any  medicine 
whatever,  if  it  could  be  avoided.  The  state  of  the  liver,  as  far  as 
it  could  be  ascertained,  remained  the  same. 

Remarks. — This  case  is  an  example  of  the  arrest  of  the  progress 
of  organic  disease  in  one  organ,  by  the  removal,  or  at  least  the  miti- 
gation of  the  disease  it  produces  in  another  with  which  it  is  nearly 
allied  in  function  and  sympathy.  Here  we  have  scirrhous  hardness 
of  the  liver,  with  an  uneven  tuberous  surface,  presenting  all  the 
features  of  disseminated  cancer,  with  which  is  associated  disease  of 
the  stomach,  assuming  at  times  the  form  of  acute,  and  ultimately 
the  symptoms  of  confirmed  chronic  gastritis.  Diseases  of  this 
character  are  commonly  treated  with  courses  of  mercury,  sarsa- 
parillaj  and  nitric  acid;  and  what  is  the  consequence?  The 
patients  continue  to  emaciate,  and  fall  victims  to  this  plan  of  treat- 
ment ;  if  it  had  been  different,  their  lives,  probably,  might  have  been 
prolonged  for  years.  I  have  seen  numerous  instances  of  these  forms 
of  disease  whether  of  the  tuberous  kind,  simple  hypertrophy,  or 
chronic  inflammation,  in  which  the  patients  have  sunk  during 
courses  of  mercury.  The  evil  appears  to  rest  in  considering  the 
hepatic  disease  as  a  pure  entity,  over  which  mercury  exerts  some 
specific  power,  without  taking  into  consideration  the  pathologic 
state  which  the  disease  of  the  liver  produces  in  other  organs,  par- 
ticularly in  the  stomach  ;  the  latter  disease  being  much  more  serious 
and  alarming  and  more  certainly  and  speedily  fatal  than  the  hepatic 
which  produced  or  is  associated  with  it.  The  remark  of  Louis  is 
here  of  great  value,  "  That,  during  the  course  of  any  disease  ac- 
companied by  febrile  action,  the  gastric  and  gastro-enteric  mucous 
surfaces  are  liable  to  put  on  a  chronic  or  subacute  form  of  inflam- 
mation, which  is,  in  a  great  majority  of  instances,  of  actually  more 
importance  than  the  primitive  disease,  and  which  becomes  the  more 
immediate  cause  of  the  patient's  death."1  The  detail  of  the  above 
case  exemplifies  the  truth  of  this  remark,  for  we  observe  that, 
although  no  impression  is  made  upon  the  hepatic  disease,  still  the 
patient  is  restored  to  a  tolerable  degree  of  health  from  attention  to 
the  state  of  the  stomach  alone.  I  could  multiply  instances  of 
this  kind.  I  am  at  present  atttending  a  lady,  in  whom  per- 
cussion indicates  considerable  enlargement  of  the  liver,  which 
produces  periodical  attacks  of  gastritis,  during  the  accession  of 
which  she  is  alarmingly  ill.  A  mild  antiphlogistic  plan,  with 

1  De  la  Gastro-enierite,  &c. 


INFLUENCE    OP    ITS    MORBID    STATES    ON    THE    LIVER.         95 

hardly  any  other  medicine  than  the  ponderous  carbonate  of  mag- 
nesia with  morphia,  have  hitherto  succeeded  in  speedily  restoring 
her,  whilst  the  hepatic  disease  hardly  appears  to  make  any  inroad 
upon  her  constitution. 

The  mere  coincidence  of  inflammatory  diseases  of  the  stomach, 
duodenum,  or  intestines  with  diseases  of  the  liver,  whether  these 
consist  in  simple  hypertrophy,  induration,  softening,  cancerous 
deposits,  vascular  turgescence,  or  inflammation  and  its  terminations, 
would  be  a  powerful  argument  against  the  employment  of  a  treat- 
ment exclusively  directed  to  the  removal  of  hepatic  disease,  when 
this  treatment  generally  consists  in  the  employment  of  remedies 
decidedly  hurtful  to  the  affections  of  the  mucous  surfaces  of  the 
stomach  and  duodenum,  and  we  recollect  that  the  patients  generally 
fall  victims  to  diseases  either  primarily  or  secondarily  established  in 
the  mucous  surfaces  of  these  organs. 

If,  by  the  careful  examination  of  the  history  of  diseases,  the 
results  of  treatment,  and  post-mortem  researches,  we  can  establish 
any  direct  connection  between  the  diseases  of  the  two  organs,  the 
influence  of  one  upon  the  other,  or  of  each  separately  upon  the 
economy  at  large,  we  may  hope  to  arrive  at  a  more  rational  and 
certain  plan  of  treatment,  and,  consequently,  one  more  successful 
than  has  yet  been  adopted. 

The  pathological  researches  of  Andral,  contained  in  the  Clinique 
Medicale,  extend  to  examinations  of  forty-five  cases  of  various  forms 
of  hepatic  disease  of  the  mucous  coats  of  the  stomach,  duodenum, 
and  small  and  large  intestines,  but  chiefly  of  the  two  former :  and 
the  forms  of  disease  observed  were  chiefly  chronic  or  subacute  in- 
flammation and  its  consequences.  Gastritis  almost  invariably  co- 
incided with  induration  and  hypertrophy,  with  softening  and 
abscess  of  the  liver.  Nine  cases  of  cancer  of  the  liver  are  given  ; 
in  five  the  same  disease  existed  in  the  stomach,  and  in  the  remain- 
ing four  aggravated  chronic  gastritis.  Some  cases  detailed  by  Cru- 
veilhier1  are  of  the  same  character,  who  remarks  that  nothing  is 
more  common  than  to  observe  cancerous  disease  of  the  liver 
co-existing  with  the  same  disease  in  the  stomach.  Broussais,2 
Villela,3  and  Berard4  also  notice  the  almost  invariable  connection  of 
diseases  in  the  two  organs. 

Having  considered  hypertrophy  of  the  liver  in  conjunction  with 
an  inflamed  condition  of  the  mucous  membrane  of  the  stomach,  we 
pass  to  the  notice  of  more  distinct  forms  of  inflammatory  disease  in 
the  liver,  under  the  characters  of  true  hepatitis  and  abscess. 

1  Anatomie  Pathologique. 

2  Histoire  des  Phlegmasies  Chroniques,  t.  3,  art.  Maladies  du  Foie. 

3  Lettre  a  P.  J.  V.  Broussais,  Histoire  des  Phlegmasies  Chroniques,  t.  3, 
p.  367. 

*  Dictionnaire  de  Medecine,  2de  edition,  art.  Maladies  du  Foie,  par 
Ferrus,  et  P.  Berard. 


96  PARKER  ON  THE  STOMACH. 

CASE  4, — Gastroenteritis — Softening  and  disorganisation  of  the  liver  in  its 

left  lobe. 

In  November  1834,  Mrs.  D.  was  placed  under  my  care.  She 
was  mother  of  two  children,  and  attributes  the  origin  of  her  disease 
to  exposure  during  the  puerperal  state.  She  had  been  ill  two  years, 
with  daily  vomiting  of  food,  pain,  weight,  and  distension  in  the 
epigastrium,  with,  during  the  latter  part  of  her  illness,  purging  of 
slimy  and  bloody  fluids. 

Nov.  11. — Constant  vomiting,  the  stomach  retains  nothing  taken 
into  it.  Four  or  five  bloody  evacuations  daily.  Great  tenderness 
in  the  epigastrium,  which  region,  with  the  hepatic,  is  hard  and 
resisting.  The  tenderness  exists,  on  pressure  in  other  parts  of  the 
belly,  which  is  full  and  tumfd.  Extreme  emaciation.  The  lungs 
and  heart  afford  no  evidence  of  disease. 

This  poor  lady  died  a  few  days  after  she  came  under  my  care ; 
her  state  at  that  time  rendering  her  recovery  hopeless. 

Post-mortem  examination,  twenty  hours  after  death. — Liver 
much  enlarged,  the  left  lobe  occupying  nearly  the  whole  of  the  left 
hypochondrium,  and  the  right  extending  downwards  many  inches 
below  the  convexities  of  the  ribs;  its  texture  tolerably  firm  on  its 
upper  surface,  the  under  breaking  down  every  where  under  the 
least  pressure  of  the  finger,  particularly  under  the  surface  of  the 
left  lobe;  The  peritoneum  and  great  omentum  generally  pinky  ; 
no  effusion  of  lymph  or  serum  ;  no  adhesions.  Pyloric  portion  of 
the  stomach  uniformly  red,  with  occasional  clusters  of  deep  red 
points;  in  others  patches  of  vivid  arborescence ;  a  viscid  muco- 
sanguineous  secretion  covered  the  inflamed  parts,  with  difficulty 
separated  from  the  mucous  membrane.  The  redness  increased 
towards  the  pylorus,  the  whole  of  the  duodenum  of  a  deep  florid 
red,  as  well  as  the  jejunum,  the  red  points  approaching  here  to 
blackness,  and  the  arborescence  of  a  modena  red.  The  membrane 
of  the  ilium  slightly  pink,  but  approaching  pretty  much  to  its 
natural  state  till  near  the  ilioccecal  valve,  where  it  was  uniformly  in 
a  black  gangrenous  state ;  this  appearance  extended  through  the 
colon  ;  small  patches  of  blood  were  effused  here  and  there.  Gall- 
bladder distended  with  black  viscid  bile. 

Remarks, — The  symptoms  observed  during  the  history  of  this 
case  point  to  the  gastric  mucous  surfaces  as  the  point  of  commence- 
ment? of  the  disease.  The  progress  of  the  inflammation  from  the 
stomach  and  duodenum,  through  the  small  intestines,  to  the  colon, 
is  well  marked  by  the  advance  of  the  symptoms,  the  extension  of 
the  tenderness  from  the  epigastrium  and  right  hypochondrium  to 
the  abdomen  generally,  and  ultimately  the  diarrhoea  and  bloody 
evacuations.  We  find,  on  examining  the  liver,  that  it  is  hypertro- 
phied,  and  some  parts  of  its  tissue  disorganised,  breaking  down  on 
the  least  pressure.  The  left  lobe  was  in  a  true  state  of  softening, 
the  result  evidently  of  the  extension  of  a  chronic  inflammatory  ac- 
tion from  the  neighbouring  mucous  surfaces  to  the  substance  of  the 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER.  97 

liver  itself.  We  have  another  point  worthy  of  notice  in  this  case— 
the  change  in  the  character  of  the  bile.  The  secretions  must 
inevitably  be  deranged  when  the  organs  furnishing  them  are  them- 
selves diseased;  hence  the  viscidity  and  dark  colour  of  the  bile, 
with  a  probable  alteration  in  its  chemical  as  well  as  physical  charac- 
ters, the  consequence  of  the  pathologic  state  of  the  liver. 


CASE  5. — Gastritis,  succeeded  by  hepatitis. — Abscess  of  the  liver. — Dropsy. 
— Dyspeptic  symptoms  for  two  years. 

In  the  month  of  August,  1834, 1  was  requested  to  see  Mr.  R , 

who  had  suffered  from  a  train  of  what  are  called  dyspeptic  symp- 
toms for  two  years.  About  that  period  prior  to  the  present  date  he 
had  been  suddenly  seized  with  acute  pain,  which  he  referred  to  the 
centre  of  the  epigastrium;  a  sense  of  great  uneasiness,  nausea,  and 
pain  followed  each  meal,  and  his  food  was  occasionally  vomited. 
He  was  subjected  to  various  plans  of  treatment  for  some  time,  but 
with  little  real  benefit.  At  length  a  spontaneous  discharge  of  blood 
took  place  from  the  anus,  and  the  stomach  was,  in  consequence,  so 
much  relieved  that  he  ceased  to  regard  it,  although  it  was  occa- 
sionally a  source  of  great  inconvenience  to  him.  He  has  indulged 
to  a  great  extent  in  "dram-drinking,  and  has  for  years  been  subject 
to  distressing  palpitations. 

Present  state. — Constant  pain  referred  by  the  patient  to  the  epi- 
gastrium, which  region  is  hard,  full,  and  resisting,  and  exceedingly 
sensible  to  pressure.  Peculiar  sharpness  of  the  pulse,  which  is 
easily  compressed.  Examination  of  the  heart  by  auscultation  detects 
merely  a  tumultuous  and  irregular  beating,  by  which  the  two  sounds 
of  the  heart  are  completely  hidden.  This  irregularity  is  not  accom- 
panied by  any  "bruit  de  soufflet."  Soon  after  this  report  the  patient 
became  ariasarcous,  and  subsequently  ascitic.  On  September  2d 
he  was  suddenly  seized  with  difficulty  of  breathing,  and  expired. 

Post-mortem  examination,  twenty-four  hours  after  death. —  Tho- 
rax.— Several  pints  of  bloody  serum  were  effused  into  each  side  of 
the  chest.  The  bronchial  mucous  surfaces  much  injected.  The  peri- 
cardium every  where  intimately  adherent  to  the  heart,  from  which  it 
was  with  difficulty  partially  separated.  The  muscular  parietes  of  the 
ventricles  of  the  heart  thin  and  flabby,  their  substance  filled  with  ec- 
chymoses.  The  aorta,  at  its  origin,  was  dilated  into  a  sac,  which 
would  contain  an  orange.  In  several  points  the  lining  membrane 
was  softened  and  ulcerated,  and  the  two  external  coats  dilated;  so 
that  a  number  of  small  aneurisms  existed  in  the  coats  of  the  large 
one. 

Stomach. — The  whole  internal  surface  of  a  deep-red  colour, 
towards  the  pylorus  approaching  to  blackness;  the  large  veins 
running  under  the  mucous  coat  were  in  a  highly  congested  state. 
Near  the  pylorus  the  papillae  of  the  mucous  membrane  were  en- 
larged to  the  size  of  pins'  heads,  and  considerably  elevated  above 
11— f  park  7 


98  PARKER  ON  THE  STOMACH. 

the  surface.  In  places,  chiefly  near  the  pylorus,  were  disseminated 
patches  of  arborescence  intensely  red,  and  accumulations  of  red 
points  in  patches  the  size  of  a  sixpence.  The  same  appearances 
were  observed,  with  some  slight  modifications,  throughout  the  duo- 
denum. 

The  liver  was  enlarged,  but  not  to  a  great  extent;  its  substance 
softened,  with  small  collections  of  pus  in  different  parts. 

Remarks. — The  history  of  this  case  clearly  demonstrates  the 
commencement  of  the  diseases  of  the  abdominal  viscera  in  the  sto- 
mach. We  have  here  a  person  addicted  to  dram-drinking  troubled 
with  dyspeptic  symptoms,  which  suddenly  assume  the  appearance 
of  gastritis  ;  this  relieved,  in  its  more  serious  symptoms,  by  a  sudden 
and  spontaneous  hemorrhage  from  the  rectum,  not  dependent  upon 
hemorrhoidal  disease.  The  symptoms  still,  however,  continue  in 
a  minor  degree,  which  is  evident  from  the  painful  digestion,  with 
the  epigastric  pain  and  tenderness.  The  patient,  after  a  time,  be- 
comes anasarcous,  ascitic,  and  dies  from  effusion  into  the  chest. 
The  post-mortem  appearances  confirm  the  symptoms  observed  dur- 
ing life;  extensive  inflammatory  disease  of  the  pyloric  portion  of 
the  stomach,  proceeding  along  the  duodenum  to  the  liver,  where  it 
terminates  in  suppuration,  most  probably  from  the  propagation  or 
extension  of  the  inflammatory  action  from  the  mucous  membrane 
of  the  duodenum  to  that  lining  the  common  and  the  hepatic  ducts. 

CASE  6. — Dyspeptic  symptoms  for  four  years. — Redness,  with  softening,  of 
the  mucous  membrane  of  the  stomach. — Abscess  of  the  liver.1 

A  patient,  aged  fifty  years,  had  been  subject  for  four  years  to  a 
class  of  symptoms  which  appeared  to  originate  in  the  stomach,  and 
which  had  been  produced  by  moral  causes.  During  this  period, 
the  appetite  had  been  variable — at  times  morbidly  increased,  at 
others  wanting  altogether;  nausea  arid  diarrhoea  had  occasionally 
been  present,  accompanied  by  wandering  pains  in  the  right  side. 
Suddenly  these  symptoms  had  assumed  a  more  acute  type.  Fever, 
with  shivering,  had  set  in ;  general  yellowness  of  the  skin  ;  total 
loss  of  appetite;  acute  pains  in  the  region  of  the  stomach,  but  none 
in  the  region  of  the  liver;  pains  in  the  left  side,  with  slight  oppres- 
sion :  to  which  were  subsequently  added  sickness,  with  looseness 
of  the  bowels.  At  a  period  of  his  disease  still  more  advanced,  the 
jaundiced  colour  of  the  skin  became  deeper.  He  had  intense 
headach ;  the  respiration  was  accelerated,  hurried,  and  irregular. 
On  examining  the  region  of  the  liver,  a  resistance  was  observed 
which  extended  from  under  the  false  ribs  on  the  right  side  into;  the 
epigastric  region.  In  this  point,  acute  lancinating,  or  obtuse  pains, 
variable  in  their  intensity  and  duration,  were  complained  of  during 
the  continuance  of  his  disease.  During  the  last  three  days  of  his 

1  Louis,  Memoires  sur  diverses  Maladies.    Abces  du  Foie.    Case  iv.  p. 
386. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER.  99 

disease  the  tongue  was  in  a  natural  state;  previous  to  this  it  had 
been  much  loaded.  He  sunk,  and  died  in  a  state  of  delirium  on 
the  30th  of  October,  fifteen  days  after  the  invasion  of  the  acute 
symptoms. 

Post-mortem  examination,  seventeen  hours  after  death. — The 
stomach  presented  several  pathologic  changes  worthy  of  remark. 
In  its  greater  curvature  the  mucous  membrane  was  covered  with 
red  points,  and  much  softened.  The  pyloric  portion  was  perfectly 
healthy;  the  intermediate  space  presented  a  gray  colour,  slightly 
injected.  Disseminated  over  this  part  of  its  surface  were  numerous 
small  ulcerations.  The  mucous  membrane  was  here  much  thick- 
ened. The  liver  was  in  all  parts  considerably  softened.  Its  in- 
terior, more  particularly  the  substance  of  its  obtuse  border  contained 
a  number  of  small  abscesses.  The  gall-bladder  .was  small,  con- 
tained a  li'ttle  mucous,  and  was  obliterated  at  its  neck;  the  cystic 
duct  contained  a  small  calculus,  the  mucous  membrane  and  sub- 
mucous  cellular  tissue  were  thickened  and  slightly  indurated. 

Remarks. — In  this  case  we  have  an  example  of  abscess  of  the 
liver  terminating  a  long  series  of  dyspeptic  symptoms,  which  are 
explained  by  the  state  in  which  the  mucous  membrane  of  the 
stomach  is  fouod  after  death.  Louis  details  five  cases  of  abscess 
of  the  liver,  all  of  which  commenced  with  a  class  of  symptoms 
referable  to  the  stomach  and  bowels,  and  four  of  these  cases  exhi- 
bited inflammatory  conditions  of  the  mucous  membrane  of  these 
organs,  when  examined  after  death.  In  the  fifth  case,  although  no 
inflammatory  condition  of  the  mucous  membrane  of  the  stomach 
was  present,  it  was  much  thickened.  In  the  six  cases  related  by 
Andral  in  the  Clinique  Medicare,  all  but  the  first  were  preceded  by 
a  class  of  symptoms  dependent  on  a  morbid  state  of  the  same  parts. 
Some  of  the  cases  were  preceded  by  derangements  proper  to  the 
lower  portion  of  the  alimentary  canal ;  others,  again,  and  these  by 
far  the  greater  number,  followed  affections  of  the  upper  part,  as  the 
stomach  and  duodenum. 

Of  all  the  affections  of  the  liver  in  which  this  organ  presents 
any  change  in  its  structure,  perhaps  that  lesion  termed  "cancer," 
whether  in  its  hard  or  soft  form,  is  most  invariably  preceded  or  ac- 
companied by  symptoms  of  a  morbid  condition  of  the  mucous  mem- 
brane of  the  stomach;  and  most  commonly,  in  examinations  after 
death,  is  the  change  found  to  exist  simultaneously  in  both  organs, 
as  the  researches  of  Cruveilhier,  Berard,  and  others,  most  certainly 
prove.  "As  well  as  the  other  diseases  of  the  liver,  already  men- 
tioned, cancer  of  this  organ  is  most  frequently  accompanied  during 
life  by  gastro-intestinal  symptoms;  and  frequently,  though  not 
always,  traces  of  inflammation  are  found  in  the  digestive  tube,  and 
particularly  in  the  stomach."1 

1  Andral.  Clinique  Medicale,  p.  967. 


100  PARKER    ON    THE    STOMACH. 


CASE   7.1 — Cancer  of   the   liver. — Chronic   inflammation   of  the   stomach 

and  duodenum. 

A  public  writer,  thirty-seven  years  of  age,  who  had  previously 
enjoyed  a  good  state  of  health,  after  having  been  exposed  to  a  cur- 
rent of  cold  air  when  in  a  state  of  perspiration,  was  suddenly  seized 
with  the  symptoms  of  cholera  morbus.  These  disappeared  in  a 
few  days,  but  from  this  moment  he  felt  a  difficulty  in  digesting  his 
food  hitherto  unknown  to  him;  the  presence  of  food  excited  in  him 
a  feeling  of  fulness  and  abdominal  distension.  He  had  also,  at 
times,  some  looseness  of  the  bowels.  Three  years  passed  on  in 
this  way ;  he  then  became  jaundiced. 

On  being  examined  at  this  period  a  body  was  discovered  in  the 
right  hypochondrium,  with  an  uneven  surface,  which. terminated 
in  a  thin  edge  a  little  above  the  umbilicus,  and  extended  into  the 
epigastrium  a  little  beyond  the  xyphoid  cartilage.  The  patient  did 
not  feel  Jhe  presence  of  this  tumour;  he  had  never  felt  the  least 
pain  in  it,  neither  did  pressure  produce  any.  For  a  long  time  back 
the  patient  had  lost  all  appetite;  when  he  took  the  least  aliment, 
solid  or  fluid,  into  the  stomach,  he  experienced  a  general  indisposi- 
tion, and  at  the  same  time  a  swelling  at  the  epigastrium,  but  never 
any  real  pain.  A  great  quantity  of  gas  was  voided  by  the  mouth; 
he  had  scarcely  vomited  two  or  three  times  when  his  digestion  be- 
gan to  be  deranged.  He  complained  of  often  feeling  pulsations  of 
the  heart,  preceded  by  rather  an  acute  pain  in  the  prsecordial 
region.  He  also  experienced  from  time  to  time  very  distressing 
headachs,  disturbances  of  vision,  formications  in  the  hands  and 
feet,  and  temporary  contractions  of  the  different  muscles.  For 
several  months  back  the  frequent  diarrhoeas  to  which  he  had  been 
subject  were  succeeded  by  obstinate  constipation ;  the  latter  set  in 
at  about  the  time  the  jaundice  appeared.  The  pulse  was  uniformly 
frequent,  the  palms  of  the  hands  burning  hot,  the  skin  always  dry; 
and  the  patient  complained  of  very  troublesome  itching. 

No  remark  is  made  upon  the  plan  of  treatment  adopted,  further 
than  the  exhibition  of  some  Yichy  water.  "This  had  no  other 
effect  than  that  of  lighting  up  fever,  and  of  exciting  pains  in  the 
epigastrium  which  the  patient  had  not  previously  felt."  Shortly 
after  this  symptom  of  inflammation  of  the  lung  and  pleura  of  the 
right  side  set  in,  of  which  the  patient  died. 

Post-mortem  examination. — The  liver  formed  in  the  abdomen 
a  large  tumour.  On  cutting  into  its  interior  it  was  found  to  contain 
a  number  of  whitish  masses,  hard  and  soft,  reduced  to  a  pap ;  several 
streaked  with  reddish  lines,  which  left  between  them  certain  areolae, 
varying  in  form  and  size ;  others  had  blood  effused  into  the  midst 
of  them.  There  was  bile  in  the  gall-bladder. 

The  internal  surface  of  the  stomach  presented,  through  its  entire 

1  Andral,  Clinique  Medicale,  "Maladies  du  Foie,"  Case  23. 


. 

INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LIVER.          101 

extent,  a  slate  colour,  the  seat  of  which  was  in  the  mucous  mem- 
brane; this  membrane  was  thickened,  indurated,  and  uneven  at  its 
surface.  The  same  colour  was  continued  into  the  duodenum,  the 
follicles  of  which  were  observed  to  be  very  much  enlarged.  Over 
the  rest  of  the  digestive  tube  nothing  was  observed  but  large  oval 
patches,  with  black  points  towards  the  termination  of  the  ileurr, 
and  a  brown  colour  of  the  caecum. 

Remarks. — This  case  is  instructive  in  many  points.  We  ob- 
serve, in  the  first  place,  the  symptoms  of  acute  inflammation  of  the 
stomach  and  bowels,  after  which  the  digestive  functions  remain 
permanently  deranged.  Three  years  after  the  commencement  of 
these  symptoms  jaundice  appears,  and  at  the  same  time  examination 
detects  a  tumour  in  the  region  of  the  liver.  The  derangement  in 
the  stomach  is  explained  by  the  state  of  this  organ,  as  observed 
after  death.  We  then  find  a  chronic  state  of  inflammation,  into 
which  the  acute  disease 'at  first  noticed  had  passed,  and  in  which  it 
remained.  The  results  of  what  little  treatment  was  adopted  are 
worthy  of  remark.  The  exhibition  of  the  Vichy  water,  which  is 
highly  charged  with  carbonic  acid,  had  no  other  effect  than  that  of 
lighting  up  fever  and  producing  pain  in  the  stomach.  There  can 
be  no  question  but  that  the  disease  observed  in  the  liver  after  death 
in  this  case  was  produced  by  the  gastro-intestinal  irritation,  under 
the  influence  of  which  the  hepatic  disease  was  called  into  existence. 
In  remarking  upon  the  frequent  coincidence  of  cancerous  diseases 
in  the  stomach  and  liver,  Cruveilhier  supposes  that  the  disease  may 
be  communicated  to  the  stomach,  when  first  developed  in  the  liver, 
through  the  medium  of  the  veins  of  the  portal  system.  I  have 
before  shown  that,  in  this  manner,  disease  is  frequently  propagated 
from  the  stomach  to  the  liver. 

The  symptoms  observed  in  the  digestive  functions,  which  pre- 
cede the  development  of  what  are  termed  cancerous  diseases,  are 
variable.  Sometimes  the  symptoms  of  mere  inflammatory  indiges- 
tion are  alone  present;  such  as  distension  and  pain  after  food,  acid 
eructations,  and  occasional  vomiting.  Again,  they  are  preceded 
by  long-continued  diarrhoea,  showing  an  habitual  state  of  irritation 
of  the  intestinal  mucous  surfaces.  The  inflammatory  symptoms 
observed  in  the  mucous  membrane  of  the  stomach  may  succeed  to 
an  injury  of  this  organ,  from  the  irritation  of  which  disease  of  the 
liver  may  be  produced :  of  this  mode  of  its  origin  Andral  reports 
an  example.  In  a  fourth  form,  hematemesis  may  be  the  first  form 
of  stomach  derangement  observed. 

Hydatids,  acephalocysts,  or  serous  cysts,  are  frequently  develop- 
ed in  the  liver,  and  constitute  not  the  least  frequent  of  its  patholo- 
gic states.  These  cysts  may  be  formed  under  the  influence  of 
gastro-intestinal  irritation,  or  the  latter  affection  may  succeed  to 
them,  and  thus  become  the  proximate  cause  of  death.  In  no  organ 
are  these  so  frequent  as  in  the  liver,  and  this  is  owing,  says  Cru- 
veilhier, to  the  peculiar  functions  of  the  liver,  viz.,  that  it  is  the 
centre  towards  which  is  determined,  and  through  which  passes,  all 


102  PARKER  ON  THE  STOMACH. 

the  venous  blood  of  the  abdomen.  To  mo-rbid  states  of  this  blood, 
produced  from  aliment  imperfectly  elaborated,  or  molecules  mixed 
with  it,  but  not  assimilable  to  the  structure  of  organs,  this  patholo- 
gist attributes  the  origin  of  hydatids  of  the  liver;  hence  a  morbid 
state  of  the  digestive  mucous  surfaces  is  very  likely  to  give  rise  to 
the  formation  of  blood  possessing  properties  to  which  Cruveilhier 
attributes  the  origin  of  hydatids  of  the  liver. 

VI. — *On  the  Influence  of  morbid  states  of  the  Stomach  upon 
the  formation  of  biliary  Calculi. 

It  is  hardily  possible  that  a  secreting  organ  like  the  liver,  the 
source  of  a  product  so  necessary  to  the  completion  of  the  digestive 
process,  can  be  altered  in  any  way  without  the  bile  which  it  se- 
cretes becoming  altered  in  its  condition  also.  Again,  we  can 
hardly  say  that  the  liver  is  perfectly  healthy  in  any  state  where  the 
digestive  mucous  surfaces  exhibit  marked  signs  of  disease.  In 
these  circumstances  we  find  the  liver  either  harder  or  softer  than 
natural,  or  the  seat  of  an  unusual  quantity  of  blood,  thence  called 
sanguineous  congestion  of  the  liver.  I  believe  that  no  case  of  in- 
flammation or  vascular  irritation  of  the  mucous  membrane  of  the 
stomach  can  occur  without  one  of  these  states  of  disease  in  the 
liver.  This  being  established,  we  naturally  look  to  the  state  of 
the  secretions  produced  under  this  condition  of  the  secreting  or- 
gan; and  in  this  enquiry  we  shall  find  that  facts  fully  carry  out  the 
opinions  we  had  formed  on  these  points.  In  most  persons  dying 
from  gastric  diseases,  or  from  other  diseases  in  which  there  is  a 
serious  complication  of  morbid  conditions  of  the  stomach,  we  find 
the  contents  of  the  gall-bladder  altered  in  their  character,  and  very 
commonly  the  lining  membrane  of  this  organ  itself  inflamed,  soft- 
ened, or  otherwise  diseased.  In  these  states  the  contents  of  the 
gall-bladder  are  generally  of  extreme  viscidity ;  the  bile  is  black, 
resinous,  adhesive,  much  thicker  than  in  its  natural  state,  and  of  a 
deep-black  colour.  I  have  noticed  this  condition  of  the  bile  in  al- 
most every  instance  I  have  examined  after  death  from  gastro-hepa- 
tic  disease.  Similar  facts  have  been  noticed  by  Portal1  and  others. 

CASE  I. — A  young  lady  had  been  subject  for  some  time  to  acute 
pains  in  the  bowels  and  stomach,  which  had  terminated  in  hiccup 
and  obstinate  vomiting.  The  patient  died  in  a  state  of  extreme 
emaciation.  On  examination  after  death  the  liver  was  found  larger 
than  natural,  adherent  to  the  diaphragm,  and  presented  some  livid 
spots.  The  ^all-bladder  contained  bile  as  black  as  pitch.  The 
intestines  were  inflamed,  the  caecum  approaching  to  a  state  of 
gangrene.2 

If  we  enquire,  for  a  moment,  into  the  nature  of  the  symptoms 

1  Maladies  du  Foie,  art.  xiii.,  •"  De  1'etat  du  Foie  dans  quelques  personnes 
qui  ont  eprouve  des  Dyspepsies,  &c." 

2  Lieutaud,  Historia  Anatomico-Medica,  lib.  i.,  Obs.  441. 


INFLUENCE  OF   ITS  MORBID  STATES  ON  THE  LIVER.  103 

which  precede  the  formation  of  biliary  calculi,  we  shall  find  them, 
in  most  instances,  limited  to  those  which  indicate  a  disordered  or 
diseased  condition  of  the  stomach — which  characterise  either  vascu- 
lar or  nervous  irritation  of  that  organ.  I  possess  notes  of  cases  of 
death  produced  by  biliary  calculi  obstructing  the  cystic  and  common 
ducts,  which  have  been  preceded  by  symptoms  of  inflammatory  in- 
digestion for  twenty  or  thirty  years.  Sometimes  the  symptoms  of 
disease  observed  in  the  stomach  are  purely  of  the  inflammatory 
kind  ;  in  others  they  are  marked  by  attacks  of  acute  pain,  recurring 
at  longer  or  shorter  intervals :  but  in  all  the  cases  I  have  had  op- 
portunities of  examining  after  death,  more  or  less  disease  of  the 
inflammatory  kind  has  been  observed  in  the  stomach,  as  well  as 
the  consequences  of  inflammation  in  the  liver.  Bonet1  contends 
for  the  gastric  origin  of  biliary  calculi,  which  he  conceives  to  arise 
from  irritation  originally  seated  in  the  stomach,  thence  propagated 
to  the  liver,  which,  causing  alterations  in  the  nature  of  its  secre- 
tions, terminates  in  the  formation  of  gall-stones.  The  same  view 
is  sustained  by  Jolly,2  who  attributes  their  origin  to  alterations  of 
the  secretions  of  the  liver,  determined  by  the  inflammatory  state  of 
the  secreting  organ. 

CASE  2. — The  first  case  of  this  character  which  I  shall  notice 
is  that  of  a  lady,  aged  forty,  who  had  suffered  severely  from  the 
symptoms  of  indigestion  of  the  inflammatory  kind  for  twelve 
months  previous  to  my  attendance  upon  her.  These  symptoms 
had  consisted  in  violent  pain  succeeding  a  meal,  in  nausea,  fulness, 
and  vomiting.  Sometimes  the  pain  came  on  immediately  after 
taking  food,  at  other  times  it  did  not  supervene  for  an  hour  :  when 
the  pain  came  on  it  produced  sickness  and  vomiting,  and  the  food 
taken  was  rejected.  The  epigastrium  was  tender  and  painful,  the 
tongue  coated  and  dry,  and  the  bowels  confined ;  occasionally  a 
dark  offensive  evacution  was  discharged.  These  symptoms  had 
continued  for  a  year,  with  little  variation.  They  were  materially 
relieved  by  leeches,  and  blisters  applied  over  the  region  of  the  sto- 
mach, with  warm  aloetic  aperients  combined  with  morphia.  From 
a  continuance  of  this  plan  for  a  few  weeks  the  patient  became  con- 
valescent ;  she  no  longer  complained  of  her  stomach,  the  food  was 
taken  with  an  appetite,  and  digested  without  pain  or  other  incon- 
venience. Suddenly  she  was  seized  with  acute  pain  on  the  right 
side,  which  was  followed  by  the  discharge,  per  anum,  of  a  number 
of  calculous  concretions  possessing  all  the  characters  of  gall- 
stones. 

CASE  3. — A  lady,  aged  fifty-three,  had  been  subject  to  impaired 
digestion  of  the  inflammatory  kind  for  twenty-five  years.  For 
seven  months  previous  to  my  attendance  upon  her  she  had  daily 
vomited  her  food,  and  the  discharges  from  the  stomach  were  occa- 
sionally mixed  with  blood. — She  had  a  jaundiced  state  of  skin, 

1  Op.  cit.,  p.  169. 

2  Diet,  de  Med.  et  de  Chirurg.  Pratique,  tome  iv.,  p.  376. 


104  PARKER  ON  THE  STOMACH. 

and  the  stools  were  of  a  chalky  whiteness,  whilst  general  pain  and 
tenderness  existed  over  the  whole  of  the  upper  portion  of  the  ab- 
domen. The  symptoms  assumed  an  acute  form,  and  she  sunk 
from  what  appeared  to  be  violent  inflammation  of  the  mucous  mem- 
brane of  the  stomach.  On  examining1  the  body,  thirty-six  hours 
after  death,  the  stomach  was  found  to  be  one  mass  of  deep  florid 
redness,  its  lining  membrane  covered  with  bloody  mucus.  The 
liver  was  harder,  and  much  larger  than  in  the  natural  state.  The 
gall-bladder  amalgamated  with  its  tissues  ;  its  mucous  membrane 
inflamed  and  softened;  the  bile  as  thick  and  dark-coloured  as 
pitch.  It  contained  two  gall-stones,  and  a  third  was  found  in  its 
duct. 

CASE  4 — A  gentleman,  aged  fifty-seven,  began  to  suffer  from 
severe  inflammatory  indigestion  at  the  age  of  twenty.  Sometimes 
this  patient  was  troubled  with  pain  after  food;  at.  other  times  he 
had  attacks  of  vomiting.  During  the  latter  years  of  his  disease, 
the  skin  sometimes  presented  a  jaundiced  appearance,  and  the 
stools  were  perfectly  white.  He  was  at  times  suddenly  seized  with 
acute  pain  in  the  right  hypochondriac  region,  with  jaundice  and 
vomiting ;  during  these  attacks  the  tongue  generally  assumed  an 
aphthous  condition.  These  attacks  had  supervened  at  intervals 
during  the  last  two  years  of  his  life  only ;  they  were,  in  several  in- 
stances, removed,  but  from  one  of  more  severe  character  than 
usual  the  patient  sunk.  He  had  never,  after  these  attacks,  been 
known  to  pass  gall-stones,  or  other  concretions,  per  anum.  On 
examining  the  body,  twenty-four  hours  after  death,  the  mucous 
membrane  of  the  stomach  was  found  thickened  and  inflamed  to  a 
great  extent,  its  sub-mucous  veins  were  turgid  and  full,  vivid 
patches  of  redness,  approaching  a  dark  colour  in  places,  were  dis- 
seminated over  the  surface  of  the  stomach ;  these  were  more  nu- 
merous towards  the  pyloric  portion.  The  liver  was  hard,  hyper- 
trophied  to  some  extent,  and  united,  by  strong  adhesions,  to  the 
diaphragm.  The  mucous  membrane  of  the  gall-bladder  highly 
inflamed  ;  the  bile  of  a  dark  pitchy  appearance.  It  contained 
masses  of  soft  concretions,  resembling  clay,  easily  broken  up  be- 
tween the  fingers.  The  cystic  and  common  ducts  were  largely 
distended  with  the  same  matter,  by  which  they  were  completely 
obliterated. 

CASE  5 — A  divine,  between  forty  and  fifty  years  of  age,  had  for 
some  months  experienced  weight  and  uneasiness  on  the  right  side, 
accompained  by  vomiting,  which  came  on  generally  about  four 
hours  after  a  meal  ;  with  these  symptoms  were  present  others  con- 
nected with  a  disordered  condition  of  his  digestive  powers.  After 
the  exhibition  of  some  pills  composed  of  aloes,  ammoniacum,  and 
the  sulphate  of  potass,  the  patient  became  suddenly  much  worse  ; 
incessant  vomiting  set  in,  the  pulse,  previously  unsteady,  became 
more  so :  and  in  this  state  he  sunk.  On  examination  of  the  body 
after  death  the  liver  was  found  greatly  hypertrophied,  and  full  of 
steatomatous  tumours  ;  the  gall-bladder  contained  a  black  bile  and 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE    LIVER.          105 

some  calculi.  The  internal  surface  of  the  stomach  was  covered 
with  dark-coloured  patches  ;  in  the  vicinity  of  the  pylorus  its 
coats  were  so  much  thickened  that  the  stomach,  in  this  part,  would 
not  admit  of  its  customary  dilatation.1 

An  illustrious  princess,  spoken  of  by  Morgagni,  had  suffered 
from  a  continual  pain  in  the  stomach  and  bowels;  a  diarrhoea 
suddenly  came  on,  -from  which  she  died.  On  opening  the  body 
the  stomach  was  found  to  be  in  a  gangrenous  state  ;  the  gall-blad- 
der contained  a  calculus  as  large  as  a  small  pear.2 

CASE  6. — A  person,  aged  sixty,  was  seized  with  diarrhoea  and 
vomiting,  the  former  of  which  was  succeeded  by  obstinate  consti- 
pation. The  vomiting  continued,  in  spite  of  all  that  was  done  to 
relieve  it,  and  the  patient  died  with  all  the  symptoms  of  acute  in- 
flammation of  the  stomach  and  bowels.  On  examination  of  the 
body  after  death  the  stomach  and  intestines  were  found  to  be  vio- 
lently inflamed,  the  gall-bladder  scirrhous,  and  a  large  biliary 
concretion  completely  obliterated  the  passage  through  the  jejunum. 
The  cellular  tissue  between  the  liver  and  gall-bladder  was  the  seat 
of  a  chronic- suppuration.3 

CASE  7. — A  patient,  aged  sixty-three,  had  suffered  for  some 
time  from  symptoms  connected  with  a  morbid  state  of  the  digestive 
powers,  which  had  commenced  with  bilious  vomiting  and  diarrhoea 
three  months  before.  Appetite  was  nearly  gone,  and  the  little 
food  which  was  taken  occasioned  in  the  epigastric  region  a  sense  of 
weight  and  heat,  which  lasted  for  several  hours.  A  blister  applied 
over  the  epigastrium  was  of  some  use  in  assisting  digestion  ;  leeches 
had  been  applied  without  any  advantage.  He  had  jaundice  ;  the 
stools  were  of  an  ash-gray  colour  ;  he  emaciated  rapidly.  One 
morning  he  felt  a  tearing  pain  in  the  right  side,  which  was  followed 
by  acute  and  general  pain  all  over  the  abdomen.  He  died  with 
these  symptoms  of  peritoneal  inflammation  in  the  course  of  the 
night.  On  examining  the  body  after  death,  the  gall-bladder,  very 
much  reduced  in  size,  was  found  ruptured  near  its  fundus  ;  its  coats 
were  remarkable  for  their  extreme  friability.  The  cystic  and 
common  ducts  were  nearly  obliterated  by  the  thickening  of  their 
parietes.  The  hepatic  duct  was  very  much  dilated,  and  filled  with 
biliary  concretions.  The  mucous  membrane  of  the  stomach  was 
of  a  slate  colour,  and  very  much  thickened,  as  were  also  its  sub- 
jacent cellular  and  muscular  tunics.4 

OBSERVATIONS  ON  THE  PRECEDING  CASES. 

Broussais  attributes  the  formation  of  biliary  concretions  to  an 
inflammatory  condition  of  the  liver  and  gall-bladder.  We  shall 
find,  by  reference  to  the  preceding  cases,  that  a  diseased  condition 

1  Morgagni,  De  Sedibus,  &c.,  Epist  xxx.,  No.  14. 

*  Op.  cit.,  lib.  3,  Epist.  xxxv.,  Art.  18. 

8  Annales  de  la  Medecine  Physiologique,  Aout,  1827. 

4  Andral,  Clinique  Medicale,  by  Spillan,  Case  31,  p.  984. 


106  PARKER  ON  THE  STOMACH. 

of  the  mucous  membrane  of  the  latter  organ  is  the  most  uniform 
organic  change  coinciding  with  the  presence  of  concretions  in  its 
interior.  If  we  enquire  carefully  into  the  symptoms  which  precede 
the  formation  of  biliary  concretions,  or  the  existence  of  hepatic 
irritation,  we  shall  find  them  commencing  with  gastric  affections, 
evidenced  by  various  symptoms  connected  with,  and  dependent 
upon,  inflammatory  irritation  of  the  mucous  membrane  of  the 
stomach  ;  and  it  is  to  the  propagation  of  disease,  by  contiguity  of 
tissue,  from  the  mucous  membrane  of  the  stomach  to  that  of  the 
duodenum,  and  thence,  through  the  common  duct,  to  the  cystic  and 
hepatic,  that  may  be  attributed  many  of  the  diseases  of  the  excre- 
tory passages  oif  the  bile.  We  see,  in  all  the  preceding  cases, 
symptoms  of  gastric  irritation  preceding  the  formation  of  gall- 
stones for  a  longer  or  shorter  period.  In  the  first  case  marked 
symptoms  of  an  inflammatory  condition  of  the  stomach  had  pre- 
ceded the  discharge  of  gall-stones  per  anum  for  twelve  months. 
In  the  second  and  third  cases  this  state  of  the  stomach  had  been 
present  for  many  years ;  in  the  second  case  the  patient  had  suffered 
from  stomach  derangement  for  twenty-five  years.  The  subject  of 
the  third  case  commenced  suffering  at  twenty;  he  died  at  the  age 
of  fifty-seven,  and  had  been  seeking  relief  from  his  disease  during 
the  whole  of  that  time.  For  the  last  three  or  four  years  a  week 
did  not  pass  without  my  seeing  this  patient,  and  I  most  minutely 
questioned  him  on  the  whole  history  of  his  disease.  In  all  the 
other  cases  we  find  symptoms  of  a  diseased  condition  of  the  lining 
membrane  of  the  stomach  to  have  been  first  in  existence.  Loss  of 
appetite,  pain,  weight,  and  heat  after  food,  vomiting,  arid  epigas- 
tric tenderness,  were  more  or  less  present  in  each  case  ;  and  though 
the  patients  sunk  from  the  secondary  disease — that  of  the  gall- 
bladder and  its  appendages — we  find  extensive  organic  mischief, 
in  every  single  instance,  in  the  stomach  and  first  passages.  Not 
only  do  we  notice  the  symptoms  of  stomach  derangement  during 
life,  but  lesions  in  the  suffering  organ  after  death,  by  which  the 
symptoms  observed  during  life  are  explained.  The  diseases  of  the 
stomach  which  precede  these  formations  are  of  the  inflammatory 
kind,  most  probably  commencing  in  mere  hyperemia  of  the  sto- 
mach, the  result  of  over-stimulation,  from  moral  or  other  causes, 
and  thence  progressing  into  confirmed  chronic  gastritis,  terminat- 
ing, as  in  the  fourth  and  sixth  cases,  in  organic  change.  In  the 
third  case  the  patient  died  from  the  stomach  disease  alone,  by  the 
passage  of  the  inflammation  from  the  chronic  to  the  acute  state. 
The  existence  of  any  biliary  concretions  was  not  suspected  during 
life,  yet  after  death  we  find  alterations  in  the  character  of  the  bile, 
and  several  large  concretions  in  the  gall-bladder.  In  other  in- 
stances the  terminations  of  gastric  diseases  are  not  in  the  organs 
which  produced  them,  as  in  some  examples  in  the  preceding  cases. 
Thus,  in  one  instance  we  see  the  patient  sinking  from  obstructions 
of  the  gall-ducts  ;  in  a  second  from  a  biliary  concretion  obstructing 
the  jejunum.  These  concretions  were  produced  under  derange- 


INFLUENCE  OP  ITS  MORBID  CONDITIONS  ON  DROPSY.     107 

ments  of  the  liver  and  its  secretions  which  evidently  originated  in 
the  stomach,  this  organ  furnishing  symptoms  of  derangement  for 
years  before  any  affection  of  the  liver  or  its  appendages  was  sus- 
pected. It  is  this  termination  of  inflammatory  irritations  of  the 
stomach  in  diseases  of  other  organs  which  should  render  us  so 
watchful  of  their  progress. 

It  is  not  the  affection  of  the  stomach  in  itself  which  ought  to 
demand  our  watchfulness,  so  much  as  the  influence  the  latter  exer- 
cises over  the  origin,  progress,  and  termination  of  diseases  in  other 
organs.  On  the  other  hand,  a  knowledge  of  the  nature  and  treat- 
ment of  the  morbid  conditions  of  the  stomach  is  essentially  neces- 
sary towards  the  successful  management  of  a  vast  number  of  dis- 
eases, which,  although  of  a  more  prominent  character  than  mere 
gastric  irritations,  are  nevertheless  produced  by,  and  strictly  depen- 
dent upon,  them. 


CHAPTER  IX. 

ON  THE  INFLUENCE    OF    MORBID    CONDITIONS    OF    THE    STOMACH 
UPON  CERTAIN  FORMS  OF    DROPSY. 

Into  the  nature  of  dropsy  it  is  not  necessary  for  me,  in  this  en- 
quiry, to  enter.  I  merely  wish,  in  this  place,  to  notice  the  influence 
which  inflamed  conditions  of  the  stomach  exercise  upon  accumu- 
lations of  serum  in  the  peritoneum  and  other  parts,  through  the 
medium  of  the  organs  upon  which  dropsy  more  immediately,  in 
these  instances,  depends. 

Ascites  may  depend  upon  a  change  in  the  anatomical  structure 
of  many  organs,  and  commonly  is  owing  to  a  mechanical  obstacle 
preventing  the  free  return  of  venous  bicod  through  the  abdomen, 
which  may  exist  in  the  liver,  the  heart,  or  other  organs.  We  may 
consider  the  influence  of  the  stomach  upon  ascites  in  two  ways  : 
1st.  In  reference  to  the  conditions  of  those  organs  upon  which  the 
ascites  depends  ;  and  2nd.  As  it  regards  the  exhibition  of  diuretic 
remedies.  We  have  seen,  from  the  facts  brought  forward  in  this 
work,  that  an  inflamed  condition  of  the  lining  membrane  of  the 
stomach  commonly  precedes  disease  in  the  liver  and  heart,  and  in 
a  great  majority  of  instances  accompanies  both,  either  in  a  primary 
or  secondary  form.  In  one  form  we  observe  hepatic  disease,  con- 
sisting, perhaps,  in  hypertrophy,  with  induration  of  the  liver,  de- 
veloped under  a  gastric  inflammation  which  has  existed  for  years. 
Consequent  upon  the  disease  of  the  liver  ascites  comes  on;  the 
disease  in  the  liver,  of  whatever  character  it  may  be,  when  once 
formed,  re-acts  upon  the  stomach  ;  and  hence  we  so  often  observe, 
during  the  progress  of  hepatic  diseases,  periodical  attacks  of  acute 


108 


PARKER  ON  THE  STOMACH. 


or  sub-acute  gastritis  occurring.  During  the  continuance  of  the 
inflammation  in  the  stomach,  the  hepatic  parenchyma,  already 
diseased,  of  increased  density,  and  already  offering  a  mechanical 
obstacle  to  the  return  of  blood,  becomes  still  more  congested,  and  is 
thrown  into  a  state  of  active  hyperemia;  and,  in  this  condition, 
the  mechanical  obstacles  become  greater,  and  the  accumulation  in 
the  peritoneum  is  increased.  As  the  symptoms  of  gastritis  disap- 
pear or  are  subdued,  the  ascites  is  reduced  to  the  state  in  which  it 
existed  prior  to  their  occurrence. 

I  have,  for  the  two  last  years,  had  a  gentleman  under  my  care 
who  has  a  large,  hard,  hepatic  tumour,  with  an  uneven  surface, 
occupying  the  epigastric  and  hypochondriac  regions,  and  extending 
nearly  to  the  umbilicus.  He  is  ascitic  to  some  extent;  the  lower 
limbs  are  also  anasarcous.  When  he  first  applied  to  me  he  had 
confirmed  chronic  gastritis  ;  the  tongue  was  intensely  red,  the  epi- 
gastrium tender ;  he  had  acid  eructations,  abdominal  distension 
after  food,  and  almost  daily  vomiting.  Sometimes  these  symptoms 
put  on  the  acute  form ;  and  at  these  times  the  dropsical  symptoms 
were  always  increased.  The  action  of  remedies  in  this  state  is 
also  worthy  of  notice.  Some  infusion  of  broom  was  exhibited  in 
the  interval  of  the  acute  attacks  of  gastritis,  but  before  all  the 
symptoms  of  gastric  inflammation  had  disappeared.  This  pro- 
duced vomiting,  increased  the  symptoms  of  disease  in  the  stomach, 
and  instead  of  increasing  the  secretion  of  urine,  this  diminished 
under  its  use,  from  the  feverish  state  of  the  economy  induced  by 
the  inflammatory  action  in  the  stomach.  Six  or  eight  leeches 
were  now  applied  every  other  day  over  the  epigastric  region,  and 
small  doses  of  the  blue  pill  with  opium  were  administered  ;  the 
patient  was  confined  also  to  a  strict  milk  and  farinaceous  diet.  By 
these  means  the  stomach  disease  was  entirely  subdued,  though  a 
great  disposition  to  its  return  always  exists  with  such  complica- 
tions. What  produced  vomiting  when  the  stomach  was  inflamed, 
and  under  whose  use  the  urinary  secretion  diminished,  now  in- 
creases its  flow  to  the  amount  of  sometimes  two  quarts  in  the 
course  of  a  single  night.  Since  the  gastritis  has  been  cured  the 
liver  is  softer,  the  ascites  less,  and  diuretic  medicines  are  well 
borne,  and  answer  the  purposes  for  which  they  were  prescribed. 
In  ascites,  dependent  upon  hepatic  disease,  the  state  of  the  stomach 
should  always  be  carefully  examined  before  the  plan  of  treatment 
is  decided  upon.  The  complication  of  sub-acute  gastritis,  duode- 
nitis, or  enteritis,  with  the  affection  of  the  liver,  ought  to  modify 
most  materially  our  treatment  in  such  cases;  the  gastritis,  in  what- 
ever form  it  may  appear,  should  be  cured  before  stimulating  diure- 
tics are  employed.1  If  diuretic  remedies  be  administered  with  the 

r'  l  Sometimes  we  see  diuretic  remedies  administered  in  ascites  produce 
vomiting.  That  these  should  be  successful  it  is  necessary  that  the  abdomen 
should  not  be  painful,  and  that  its  contained  viscera  should  be  healthy. — 
Landre  Beauvais,  Diet,  de  Medecine,  1st.  edit.,  art.  Ascites. 


INFLUENCE  OF  ITS  MORBID  CONDITIONS  ON  DROPSY.    109 

mucous  membrane  of  these  organs  in  an  inflamed  condition,  the 
accumulations  of  serum  will  be  invariably  augmented  from  an 
increased  congestion  of  the  liver,  produced  by  the  irritation  which 
these  remedies  cause  in  the  digestive  mucous  surfaces. 

Where  the  mucous  membrane  of  the  stomach  evinces  signs  of 
disease,  in  complication  with  hepatic  diseases  associated  with  dropsy, 
its  susceptibility  to  impression  is  in  many  cases  much  changed. 
Sometimes  a  mild  aperient  will,  in  these  cases,  produce  a  diarrhoea 
which  we  find  some  difficulty  in  arresting ;  or,  again,  the  adminis- 
tration of  a  diaphoretic  or  diuretic  remedy  may  produce  severe 
vomiting.  In  these  states,  also,  a  single  dose  of  mercury  will 
occasion  profuse  salivation.  I  have  seen  this  the  case  in  three 
instances.  Where  the  liver  is  extensively  diseased,  the  pathologic 
change  accompanying  it  in  the  stomach  may  be  not  merely  an 
inflammatory  condition,  but  one  of  malignant  disease,  or  of  ulcera- 
tion,  which  would  require  the  utmost  caution  in  the  use  of  remedies. 

"A  government  -officer,  -aged  58,  addicted  to  the  free  use  of 
wine,  who  had  some  time  previously  received  in  battle  a  blow  over 
the  stomach  and  liver,  entered  the  Hospital  Beaujon,  in  August, 
1832.  He  had  then  general  anasarca,  ascites,  and  hydro-thorax, 
with  symptoms  of  enlargement  of  the  heart.  The  region  of  the 
liver  and  that  of  the  stomach  were  painful  and  tender.  He  was 
bled  generally  and  locally,  with  relief,  for  the  pains  in  the  stomach, 
&c.  The  use  of  digitalis  was  now  commenced,  to  the  extent  of 
two  grains  a  day ;  soon  afterwards  a  relaxed  state  of  bowel  came 
on,  which  rapidly  increased  till  he  had  passed  daily,  by  stool,  five 
or  six  pints  of  limpid  serum.  The  dropsy  disappeared ;  but  in 
spite  of  all  remedies  the  purging  continued,  and  the  patient  died  in 
a  state  of  extreme  wasting.  On  examination  after  death,  the  liver 
was  found  atrophied  and  hardened.  A  cancerous  tumour  existed 
in  the  smaller  curvature  of  the  stomach."1  In  remarking  upon 
the  use  of  hydragogue  remedies  in  cases  of  various  forms  ol 
dropsy,  Martin-Solon  very  properly  observes  that  we  ought  not  to 
prescribe  them  where  the  gastro-intestinal  mucous  membrane  pre- 
sents the  symptoms  of  inflammation.  In  such  states  we  are  more 
likely  to  produce  disease  in  it  than  to  cure  the  primitive  affection. 

In  other  kinds  of  dropsy,  which  depend  upon  disease  of  the 
heart,  an  inflamed  condition  of  the  mucous  membrane  of  the  sto- 
mach is  not  the  least  frequent  of  its  complications,  I  have  men- 
tioned, in  another  part  of  this  work,2  the  case  of  a  lady  who  was 
anasarcous,  and  who  had  valvular  disease  of  the  heart  and  an 
inflamed  condition  of  the  mucous  membrane  of  the  stomach.  After 
leeching  the  epigastrium,  in  her  case,  elaterium  was  well  borne  and 
afforded  great  relief  to  the  dropsical  symptoms.  If  exhibited  with- 
out first  unloading  the  vessels  of  the  stomach,  distressing  vomiting 
was  always  produced,  and  the  anasarca  was  not  at  all  relieved. 

1  Martin-Solon,  Diet,  de  Med.  et  de  Chir.  Prat,  art  Hydragogues. 

2  See  the  chapter  on  Diseases  of  the  Heart. 


110  PARKER  ON  THE    STOMACH. 

"Different  diseases  which  manifest  themselves  during  the  pro- 
gress of  an  affection  of  the  heart,  sometimes  exercise  a  remarkable 
influence  on  the  production  of  dropsy.  In  many  instances,  it  is 
during-  a  Castro-intestinal  inflammation  that  the  dropsy  becomes 
manifest."1 

A  lady,  who  had  for  five  years  been  subject  to  periodical  vomit- 
ing, accommpanied  by  the  symptoms  of  valvular  disease  of  the 
heart,  the  chief  physical  symptom  of  which  was  an  unusually  loud 
"bruit  be  soufftet,'  became  suddenly  anasarcous.  under  an  aggra- 
vated attack  of  the  stomach  affection.  The  fever  which  accom- 
panied the  onset  of  these  acute  symptoms  assumed  a  distinct  inter- 
mittent quotidian  form.  Quinine  was  administered  for  the  relief 
of  the  latter  affection,  without  reference  to  the  pathologic  state  of 
the  stomach  or  to  the  complications  of  the  disease.  The  patient 
died  suddenly  the  third  day  of  the  treatment?  of  effusion  into  the 
chest.  I  am  convinced  that,  in  this  case,  the  occurrence  of  the 
acute  disease  in  the  stomach  produced  the  anasarca,  by  still  more 
embarrassing  the  heart's  action,  and  I  am  also  strongly  impressed 
by  the  conviction  that  had  free  local  depletion  been  made  from  the 
region  of  the  epigastrium,  this  patient's  life  might  have  been  pro- 
longed to  an  indefinite  period. 

In  the  complications  of  ascites  and  anasarca  with  diseases  of  the 
heart,  we  commonly  observe  the  ill  effects  following  the  adminis- 
tration of  digitalis ;  whilst,  in  other  instances,  the  exhibition  of  the 
remedy  is  attended  with  the  happiest  consequences.  This  arises, 
not  from  the  varying  effects  of  digitalis  as  a  therapeutic  agent,  but 
from  the  state  in  which  the  mucous  membrane  of  the  stomach  is 
found  at  the  time  of  its  exhibition. 

A  man,  sixty  years  of  age,  entered  the  Hospital  of  La  Charit<5 
with  the  symptoms  of  an  affection  of  the  heart,  to  which  had 
succeeded  a  dropsical  state  of  the  legs,  and,  subsequently,  of  the 
belly.  The  tincture  of  digitalis  was  administered  to  the  extent  of 
thirty  drops  for  a  dose.  It  occasioned  vomiting ',  which  ceased 
spontaneously  when  its  use  was  given  up.  This  patient  ultimately- 
died  of  disease  of  the  heart.  On  examining  the  body  after  death, 
the  digestive  tube  was  found  generally  injected. 

In  remarking  upon  digitalis,  as  used  for  the  purpose  of  relieving 
dropsical  effusions  in  affections  of  the  heart,  both  Broussais3  and 
Andral3  insist  on  the  most  careful  attention  being  paid  to  the  con- 
dition of  the  gastric  mucous  surfaces.  Before  administering  this 
remedy,  says  the  first  of  these  authors,  we  must  be  assured  that 
there  is  no  gastritis  to  interfere  with  its  operation.  When  this 
organ  is  prepared,  by  the  removal  of  inflammation,  for  its  adminis- 
tration, we  may  have  recourse  to  it  with  great  hopes  of  success. 

1  Andral  Clinique  Medicale,  p.  271. 

8  Cours  de  Pathologie,  et  Therapeutique  Generates,  t.  iii.  p.  144. 

3  Clinique  Medicale. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  HEART.          Ill 


CHAPTER  X. 

ON  THE  INFLUENCE  OF  MORBID  STATES  OF  THE  STOMACH  UPON 
THE  ORIGIN,  PROGRESS,  AND  TERMINATION  OF  DISEASES  OF 
THE  HEART. 

The  stomach  is  an  organ  which,  from  its  intimate  connection 
with  the  other  parts  of  the  economy,  cannot  be  long  or  seriously- 
disturbed  in  its  functions,  or  thrown  into  states  of  disease,  without 
in  some  measure,  affecting  other  organs,  with  which  it  is  so  closely 
connected.  The  reverse  of  this  proposition  is  also  true,  that  as  the 
stomach  affects  the  integrity  of  other  organs  in  states  of  disorder  or 
disease,  so  do  they  react  upon  and  disturb  it  when  they  are  thrown 
into  morbid  conditions.  These  remarks  apply  more  particularly  to 
the  connection  of  the  heart  with  the  stomach,  than,  perhaps,  to  those 
of  any  other  organ,  for  we  find  the  mutual  reaction  of  these  two 
upon  each  other,  in  states  of  disease,  to  constitute  a  circle  of  morbid 
phenomena,  which  are  not  merely  confined  to  the  organs  in  ques- 
tion, but  become  the  exciting  causes  of  other  diseases  in  remote 
parts,  the  starting  point  of  which  we  shall  trace,  in  most  instances, 
to  its  commencement  in  the  stomach  alone. 

In  the  first  series  of  observations  I  shall  trace  the  effect  of  the 
stomach  upon  the  heart.  All  inflammatory  irritations  of  the  sto- 
mach do  not  influence  the  heart's  action  ;  they  generally  affect  this 
organ  more  as  they  are  more  intense,  as  they  occur  in  patients  of 
greater  susceptibility,  or  as  they  occupy  more  immediately  the  car- 
diac portion  of  the  stomach. 

CASE  1. — Palpitations  after  meals  for  some  months;  the  meals  also  suc- 
ceeded by  flatulence  and  nausea— Subsequently  acute  gastritis,  with 
inordinate  action  of  the  heart. 

A  gentleman,  aged  forty-five,  had  suffered,  for  three  or  four 
months,  from  palpitations,  which  came  on  after  eating.  Accompa- 
nying these  palpitations  he  had  flatulence,  fulness  and  weight  in 
the  epigastrium,  with  occasional  nausea.  To  these  succeeded  throb- 
bings  in  the  neck,  a  degree  of  stupor,  and  total  inability  to  exercise 
any  intellectual  faculty  as  long  as  the  period  of  digestion  continued. 
After  the  continuance  of  these  symptoms,  in  the  manner  I  have  re- 
lated, for  about  four  months,  they  assumed  an  acute  type ;  vomit- 
ing, pain,  and  excessive  tenderness  of  the  epigastrium  set  in,  with 
thirst,  a  loaded  tongue,  vividly  red  at  the  point  and  edges,  and  in- 
ordinate action  of  the  heart.  The  pulsations  of  this  organ  were 
unusually  strong  and  frequent ;  the  pulse  rose  to  one  hundred  and 
twenty  after  taking  even  the  smallest  quantity  of  nutriment,*  the 
eyes  were  suffused,  and  the  face  slightly  swollen.  Examined  by 
auscultation  the  heart  appeared  to  possess  an  unusual  degree  of 
force  in  its  action,  but  did  not  afford  any  evidence  of  hypertrophy  nor 


112  PARKER  ON  THE  STOMACH. 

of  valvular  disease.  Two  relays  of  leeches  were  applied  over  the 
epigastrium,  by  which  all  the  symptoms  were  so  far  mitigated  as  to 
render  the  patient  nearly  convalescent.  Still  there  continued  a 
great  disposition  to  excitement  about  the  heart,  which  even  small 
quantities  of  farinaceous  food  brought  on  ;  at  the  same  time  the 
gastric  symptoms  were  also  aggravated.  The  prussic  acid  was  now 
given  freely  with  great  benefit,  allaying  the  irritability  of  the  sto- 
mach, and  at  the  same  time  quieting  the  heart's  action. 

Remarks. — This  case  may  be  taken  as  the  type  of  a  class  in 
which  symptoms  of  great  irritability  exist  naturally,  both  in  the 
stomach  and  in  the  heart — one  keeping  up  the  state  of  excitement 
in  the  other.  The  previous  history  of  the  case  shows  that  this 
irritability  of  both  organs  was  constitutional ;  for  if,  after  exertion 
which  had  accelerated  the  heart's  action,  this  patient  had  at  any 
time  taken  a  hearty  meal  of  solid  food,  symptoms  of  gastritis 
immediately  set  in.  The  violent  action  of  the  heart  preventing  the 
free  return  of  blood  from  the  vena-cava  in  such  cases,  this  fluid  is 
retained  in  the  portal  system,  and  the  mucous  surfaces  of  the  duo- 
denum and  stomach  become  mechanically  congested  with  more 
blood  than  is  necessary  to  the  fulfilment  of  their  functions.  The 
impression  of  stimulating  food  upon  a  membrane  in  this  state  only 
increases  the  mischief  by  determining  into  it  a  still  greater  quantity 
of  blood,  and  hence  true  gastritis  is  easily  brought  on.  Where  the 
heart's  action  is  habitually  energetic,  the  mucous  membrane  of  the 
stomach  is  constantly  thrown  into  this  state,  and  digestion,  in -con- 
sequence, rendered  laborious.  "  Those  persons  in  whom  the  action 
of  the  heart  is  habitually  energetic  have  generally  the  tongue  red 
and  pointed,  the  sensibility  of  trie  epigastrium  exalted,  and  the  region 
of  the  liver  and  duodenum  full  and  more  or  less  painful.  This 
results  from  the  sympathies  which  connect  the  heart  and  the  sto- 
mach ;  but  in  many  cases  it  appears  that  the  gastro-duodenal  irri- 
tation is  kept  up  by  congestion  of  blood  in  the  liver,  caused  by  the 
difficulty  experienced  by  the  vena  cava  in  discharging  its  blood 
into  the  heart,  in  consequence  of  its  hurried  action.  Treatment 
confirms  this  view,  since  we  find  leeches  applied  over  the  right 
hypochoridrium  and  the  hepatic  and  duodenal  regions  relieve  the 
symptoms  more  than  general  bleeding  or  leeches  applied  o\rer  the 
heart."1  With  regard  to  the  case  in  question,  we  observe  the 
exemplification  of  the  truth  of  these  remarks.  Naturally  energetic 
action  of  the  heart,  with  constant  symptoms  of  irritability  of  the 
stomach,  terminating  in  acute  gastritis;  accompanying  this  we  have 
an  unusual  disturbance  of  the  heart's  action,  consequent  upon  its 
constitutional  excitability.  The  results  of  treatment,  too,  correspond 
with  the  remarks  of  Broussais:  the  leeches  to  the  epigastrium 
mitigate  to  convalescence  all  the  symptoms.  Attendant  upon  the 
vascular  irritation,  which  forms  the  chief  features  of  this  case,  we 
find  a  great  degree  of  nervous  irritability,  evidenced  in  the  unusually 

1  Broussais,  Comrnentaires  des  Propositions  de  Pathologie3  t.  ii.  p.  606. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  HEART.          113 

irritable  state  of  the  heart.  In  such  a  state,  after  bleeding,  the 
hydrocyanic  acid  is  a  most  invaluable  remedy ;  and,  in  fact,  I  know 
of  no  other  article  in  the  inateria  rnedica  which  could  be  employed 
in  such  a  state,  as  its  substitute.  We  have  another  class  of  morbid 
phenomena  in  this  case,  which  are  referable  to  the  head — the  loss 
of  memory  and  thought  after  meals ;  these  are,  doubtless,  owing-  to 
a  temporary  cerebral  congestion  ;  we  observe  them  disappear  as  the 
process  of  digestion  is  completed.  Apoplexy  is  common  in  such 
states.  We  shall  allude  to  this  more  particularly  in  speaking  of  the 
influence  of  the  stomach  upon  the  brain. 

The  heart  is  not  only  influenced  in  the  force  and  frequency  of  its 
pulsations  by  inflammatory  irritation  of  the  stomach,  but  the  regu- 
larity or  rhythm  of  its  action  is  interrupted  ;  its  beats  become  irre- 
gular, tumultuous,  and  intermittent,  and  put  on  all  the  characters 
of  organic  disease ;  the  breathing  is  hurried,  and  occasionally  the 
lower  limbs  become  oedematous,  from  interruption  to  the  free  return 
of  blood  through  the  heart.  I  have  met.  with  one  very  remarkable 
case  of  this  kind,  and  a  second  is  recorded  by  Cruveilhier,  in  which 
even  the  physical  as  well  as  rational  signs  of  diseased  heart  were 
present ;  yet  on  examination  after  death  no  disease  of  the  heart  is 
apparent,  all  the  pathological  changes  being  found  in  the  stomach 
alone. 


CASE  2. — Irregular  action  of  the  heart — Intermittent  pulse — (Edema  of  the 
legs — Gastritis — No  disease  of  the  heart  to  account  for  its  irregular 
action. 

A  middle-aged  female,  addicted  for  some  time  to  the  free  use  of 
spirituous  liquors,  came  under  my  care  for  what  was  supposed  to 
be  an  organic  affection  of  the  heart.  The  pulse  at  the  wrist  was 
a  mere  unsteady  trembling  of  the  artery,  in  which  nothing  like  dis- 
tinct pulsation  could  be  discovered.  On  examination  of  the  heart 
itself  a  similar  state  of  things  was  observed.  Auscultation  indicated 
little:  There  was  merely  a  tumultuous  undulating  motion  of  the 
heart;  no  distinct  action  could  be  made  out.  Accompanying  this 
state  she  had  much  flatulence,  distension  after  food,  nausea,  arid 
vomiting,  with  considerable  pain  arid  weight  in  the  epigastrium, 
much  increased  by  pressure.  The  weak  and  emaciated  state  of 
this  patient  precluded  the  use  of  active  remedies  of  all  kinds.  After 
the  continuance  of  this  state  for  some  weeks,  she  gradually  sank 
and  died. 

On  examination  after  death  the  heart  was  found  perfectly  healthy  ; 
it  presented  no  evidence  of  disease,  either  in  its  muscular  structure, 
in  the  valves,  or  in  its  investing  or  lining  membranes.  The  sto- 
mach presented,  in  its  cardiac  portion,  one  universal  mass  of  deep 
pink  injection.  The  liver  was  hypertrophied,  its  substance  con- 
siderably more  dense  and  pale  than  in  the  healthy  state. 

Remarks. — We  have  here  an  evample  of  gastritis  exerting  a 
most  marked  influence  over  the  action  of  the  heart,  in  fact,  pro- 
11 — g  parkS 


114 


PARKER  ON  THE  STOMACH. 


ducing  symptoms  of  disease  in  this  organ,  which  appear  of  so  unequi- 
vocal a  character  that  we  are  led  to  regard  the  affection  of  the  heart 
as  the  leading  feature  in  the  disease.  If  we  dwell  upon  the  symp- 
toms furnished  by  the  heart — the  intermittent  pulse,  the  tumultuous 
motion  of  the  heart  when  examined  by  auscultation,  in  which 
nothing  distinct  in  the  action  of  the  ventricles  could  be  discovered, 
there  seerns  no  reason  to  doubt  but  that  the  patient  was  labouring 
under  an  organic  disease  of  this  viscus,  and  that  the  stomach  dis- 
ease was  dependent  upon  it.  The  post-mortem  examination,  how- 
ever, shows  the  reverse  to  be  the  fact.  We  find  after  death  a 
diseased  stomach,  and  a  healthy  heart,  at  least  as  far  as  our  senses 
are  capable  of  appreciating  a  normal  state  of  organisation.  Cru- 
veilhier  records  a  similar  case,  in  which  both  the  physical  arid 
rational  signs  of  disease  in  the  heart,  were  present.  After  death, 
however,  the  heart  was  found  perfectly  healthy;  cancerous  disease 
of  the  stomach,  with  a  similar  morbid  condition  of  the  liver,  were 
the  only  organic  changes  met  with. 

I  record  the  leading  features  of  the  case  recorded  by  Cruveilhier. 
"  The  patient  was  thirty-eight  years  of  age,  and  had  been  indis- 
posed for  five  weeks.  He  at  first  complained  of  loss  of  appetite, 
slight  uneasiness  after  food,  with  distressing  flatulence,  relaxed 
bowels,  dry  cough,  palpitations,  felt  principally  in  the  epigastrium, 
coming  on  from  the  least  exertion,  and  ceasing  after  a  few  minutes' 
repose.  No  tenderness  in  the  epigastrium  on  strong  pressure. 
These  symptoms  were  noted  on  the  15th  of  October;  on  the  1st  of 
December  there  was  no  amendment:  the  patient  then  complained 
of  weight  at  the  stomach,  nausea,  eructations,  arid  acidity,  with  some 
fever. 

"April  10th. — The  symptoms,  at  this  date,  remained  much  the 
same  ;  there  was  no  sensibility  in  the  regions  of  the  stomach  or 
liver.  Distressing  palpitations  in  the  epigastrium,  as  well  as  in  the 
region  of  the  heart,  so  strong  as  to  be  felt  all  over  the  head.  Food 
sits  heavy  upon  the  stomach  for  eight  or  ten  hours  after  eating; 
warm  drinks  occasion  distress,  cold  ones  were  agreeable  and 
refreshing.  The  stethoscope,  applied  over  the  heart,  discovered  a 
strong  and  extended  pulsation  diffused  over  the  whole  of  the  left 
side  of  the  thorax  ;  accompanying  it  was  a  whistling  sound  (bruit 
de  sifflement),  synchronous  with  the  pulsations  of  the  heart  and  the 
pulse.  It  was  concluded,  from  this  examination,  that  the  patient 
was  affected  with  hypertrophy  of  the  heart  and  disease  of  its  valves  ; 
and  a  treatment  calculated  to  retard  the  progress  of  such  a  disease 
was  consequently  adopted.  In  May  constant  vomiting  set  in.  but 
the  state  of  the  epigastric  region  remained  the  same;  there  was  no 
tenderness,  fulness,  or  tumefaction. 

"  In  August  physical  signs  of  disease  of  the  liver  were  added  to 
the  symptoms  previously  existing.  Milk  and  fruits  were  the  only 
aliment  his  stomach  could  then  retain. 

"On  examination  after  death  the  liver  was  found  filled  with 
deposits  of  encephaloid  mailer;  the  stomach  near  the  pylorus,  pre- 


INFLUENCE  OP  ITS  MORBID  STATES  ON  THE  HEART.        115 

sented  an  indurated  mass  with  considerable  thickening,  hollowed 
in  the  centre  by  a  deep  circular  ulcer.  The  heart,  the  lungs,  and 
the  remaining  organs  were  perfectly  healthy."1 

Andral  and  Broussais  both  attribute  the  occurrence  of  irregular 
and  increased  action  of  the  heart,  consequent  upon  gastric  disturb- 
ance to  predisposition  to  disease  on  the  part  of  the  heart,  character- 
ised by  a  preternatural  thickness  in  its  walls,  or  an  over-excitable 
state  of  the  nerves  distributed  to  it.  Thus  the  gastric  irritation 
becomes  the  occasional  cause  of  the  more  rapid  development  of 
disease  of  the  heart,  the  rudiments  of  which  these  persons  carry 
about  them.  I  am  often  consulted  by  patients  who  complain  loudly 
of  stomach  derangement  and  the  palpitations  which  accompany  it, 
which  only  come  on  after  meals,  to  which  they  have  been  subject 
for  years.  Although  the  stomach  is  the  organ  principally  attract- 
ing attention,  yet  when  we  come  to  examine  minutely  into  the  state 
of  the  heart,  we  find  in  it  the  physical  signs  of  disease.  I  have  two 
gentlemen  now  under  my  care  in  this  state.  It  is  impossible  to  say, 
in  such  cases,  whether  the  stomach  may  not  have  been  the  primary 
seat  of  disease  ;  but  it  is  certain  that  the  removal  or  mitigation  of 
the  symptoms  indicating  an  inflamed  state  of  the  mucous  membrane 
of  the  stomach  renders  stationary  the  evils  which  exist  in  the  heart.2 
How  common  is  it  to  see  persons,  who  carry  about  them  all  the 
signs  of  diseased  heart,  tormented  with  periodical  attacks  of  gastri- 
tis, which  are  termed  bilious  seizures,  during  the  continuance  of 
which  the  affection  of  the  heart  becomes  more  urgent  and  alarming. 
To  this  point  we  shall  return,  however,  on  examining  the  influence 
of  the  heart  upon  the  stomach.  The  two  cases  I  have  mentioned 
are  examples  of  the  most  acute  and  marked  forms,  under  which 
sympathetic  affections  of  the  heart  are  manifested,  consequent  upon 
disease  in  the  stomach  ;  these  sympathies  may.  however,  assume 
much  milder  forms,  from  the  mere  increase  in  the  force  and  fre- 
quency of  the  heart's  action  to  irregularities  of  various  kinds,  with 
an  intermittent  pulse.  These  derangements  taking  place  only 
during  the  continuance  of  disease  in  the  stomach,  they  cease  with 
it,  and  reappear  when  these  morbid  states  again  set  in. 

I  have  now  to  record  several  examples  of  peculiar  states  of  the 
pulse  dependent  upon  gastritis  or  gastric  hyperemia.3 

CASE  3. — A  young  lady,  aged  eight,  after  the  disappearance 
of  the  eruption  of  scarlatina,  was  seized  with  sickness  and  constant 
vomiting  of  food,  with  pain  arid  tenderness  in  the  epigastrium:  the 
bowels  were  constipated,  the  papillae  of  the  tongue  enlarged  and 
intensely  red.  The  pulse  was  frequent,  and  had  a  double  beat  to 

1  Anatomie  Pathologique,  &c.  12me.  livraison. 

2  "  Cure  the  gastritis  and  you  will  often  see  the  affection  of  the  heart 
become  stationary." — Andral. 

3  These  forms  of  irritation  in  the  stomach  are  evidently  combined  with 
some  peculiar  conditions  of  the  nervous  system;  the  stupor  in  some  cases, 
and  the  convulsions  in  others,  are  evidences  of  this.    Those  cases  also  illus- 
trate some  of  the  sympathies  existing  between  the  stomach  and  the  brain. 


116  PARKER  ON  THE  STOMACH. 

each  systole  of  the  heart,  two  pulsations  of  the  artery  at  the  wrist 
to  each  single  contraction  of  the  left  ventricle  of  the  heart. 

CASE  4. — A  boy,  aged  ten,  was  seized,  after  the  disappearance  of 
the  eruption  of  scarlatina,  with  constant  sickness,  vomiting,  and 
pain  and  tenderness  in  the  epigastrium.  The  bowels  were  obsti- 
nately constipated,  and  the  stomach  would  not  retain  either  food  or 
medicine.  The  pupils  were  dilated  to  the  utmost  extent.  After 
the  continuance  of  this  state  for  two  days  violent  convulsions  came 
on.  which  recurred  after  bleeding  from  the  arm,  but  did  not  again 
come  on  after  the  application  of  leeches  to  the  head  and  stomach 
at  the  same  time.  The  double  pulsation  at  the  wrist  continued 
during  the  whole  of  the  period  that  the  symptoms  of  gastric  irrita- 
tion lasted:  they  disappeared  with  the  sickness.  I  could,  in  this 
case,  predict  the  effect  which  would  follow  the  administration  of 
food  or  medicine  ;  they  invariably  produced  sickness  as  long  as  the 
double  pulsation  continued. 

CASE  5. — A  young  gentleman  aged  ten,  after  scarlatina  had  con- 
stant sickness,  pain,  sometimes  of  a  violent  character,  with  tender- 
ness in  the  epigastrium,  and  confined  bowels.  The  stomach  was 
so  irritable  that  it  would  retain  nothing  in  the  shape  of  medicine, 
excepting  a  pill  of  calomel  and  opium.  The  pupils  were  largely 
dilated,  and  he  had  occasional  fits  of  stupor.  The  symptoms  con- 
tinued many  days;  but  the  patient  ultimately  recovered  from  the 
application  of  leeches  to  the  epigastrium  and  the  occasional  use  of 
injections.  This  patient  had  a  double  pulsation  at  the  wrist  during 
the  whole  continuance  of  the  gastric  symptoms.  I  noticed  it  some 
hours  before  the  vomiting  commenced,  and  predicted  the  occurrence 
of  the  sickness  from  the  state  of  the  pulse. 

CASE  6. — A  middle-aged  man  had  diarrhoea,  with  occasional 
sickness,  and  vomiting,  distension,  flatulence,  and  uneasiness  after 
taking  food.  With  these  symptoms  of  gastro-enteric  irritation,  he 
had  a  double  pulsation  of  the  radial  artery. 

CASE  7. — An  athletic  man,  after  hard  labour  in  the  heat  of  the 
sun  for  many  hours,  was  seized  with  the  symptoms  of  acute  gas- 
tric irritation ;  great  heat  of  skin,  constant  vomiting,  pain  and  ten- 
derness in  the  epigastrium,  thirst,  dry  red  tongue,  and  tendency  to 
delirium,  with  a  tremulous  double  pulsation  of  the  artery  at  the 
wrist.  All  the  symptoms  yielded  at  once  to  the  application  of 
twenty  leeches  over  the  epigastrium.  The  pulse  then  resumed  its 
customary  single  beat. 

Remarks. — These  cases  I  have  selected  from  many  others  to 
illustrate  the  influence  of  the  stomach  upon  the  arterial  system. 
These  peculiar  states  of  pulse — sometimes  a  distinct  double  pulsa- 
tion, at  others  a  mere  tremulous  motion  of  the  artery — seem  alto- 
gether independent  of  any  action  of  the  heart  itself.  I  have  fre- 
quently had  my  ear  upon  the  stethoscope,  placed  over  the  heart, 
and  my  finger  upon  the  pulse  at  the  same  moment,  but  in  the  cases 
which  I  have  detailed,  the  action  of  the  heart  has  invariably  been 
steady,  whilst  the  pulse  presented  a  mere  tremulous  motion  or  a 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  HEART.          117 

distinct  double,  or  even  triple,  pulsation  to  each  contraction  of  the 
ventricle.  When  these  states  of  pulse  coincided  with  the  symp- 
toms of  gastric  hyperemia,  the  head  always  appeared  to  be  more  or 
less  affected:  in  some  cases,  certainly,  there  were  no  symptoms  in- 
dicating any  affection  of  the  brain ;  but  in  others  these  symptoms 
were  very  marked.  The  convulsions  in  the  third  case,  and  the  ex- 
tremely dilated  state  of  the  pupil  in  the  third  and  fourth  cases,  are 
examples  of  these  secondary  states  of  disease  in  the  head  subse- 
quently to  gastritis,  accompanied  by  this  peculiar  condition  of  the 
pulse.  Most  of  the  examples  which  I  have  collected  of  these  forms 
of  disease  have  been  after  the  disappearance  of  the  eruption  in  scar- 
latina; but  it  will  be  observed  that,  in  the  fifth  case,  no  feverish 
affection  had  previously  been  in  existence;  and,  in  the  sixth  case, 
the  peculiarity  of  pulse  coincided  with  symptoms  of  acute  gastritis, 
and  disappeared  with  the  disease,  which  was  treated  with  active 
local  depletion.  In  this  case  we  observe  the  pulse  to  resume  its 
single  pulsations  as  the  blood  flows  from  the  region  of  the  stomach. 
The  nature  of  the  symptoms  on  the  part  of  the  stomach,  and  the 
effect  of  local  depletion  from  the  epigastrium,  leave  us  no  room  to 
doubt  of  the  nature  of  the  stomach  affection ;  they  also  convince 
us  that  the  state  of  the  pulse  was  entirely  dependent  upon  it,  since 
we  see  the  action  of  the  artery  become  natural  as  the  symptoms  of 
inflammatory  irritation  are  removed. 

The  pulse  is  modified  in  a  thousand  ways  in  inflammatory  irri- 
tation of  the  stomach;  but,  in  most  of  these  instances,  it  is  influ- 
enced through  the  medium  of  the  heart.  Thus  it  is,  in  many 
cases,  languid  and  creeping,  not  exceeding  forty  beats  in  a  minute 
in  certain  forms  of  chronic  gastritis.  These  states  of  languid  cir- 
culation exist  with  symptoms  of  chronic  gastritis.  I  have  now  a 
gentleman  and  lady  under  my  care  who  have  this  state  of  circula- 
tion with  chronic  gastritis;  one  of  them  has  an  aphthous  state  of  the 
mucous  membrane  of  the  mouth  and  fauces,  obstinate  constipation, 
occasional  nausea,  with  vomiting,  flatulence,  and  acidity;  pain  and 
tenderness  in  the  epigastrium  are  almost  altogether  wanting;  he 
may  be  pressed  rudely  without  occasioning  more  than  a  mere  un- 
easiness, yet  I  consider  this  patient's  as  one  of  the  most  confirmed 
cases  of  chronic  gastritis.  In  the  case  of  the  lady,  the  symptoms 
are  still  more  obscure ;  uneasiness  after  food,  with  acidity,  lan- 
guor, rapid  wasting,  and  a  pulse  not  exceeding  forty  beats  in  a 
minute,  are  the  prominent  features  of  her  disease.  Both  patients 
have  been  materially  benefited  by  small  local  depletions  from  tha 
epigastrium. 

Broussais  would  say  these  states  of  disease  were  not  sufficiently 
acute  to  irritate  the  heart.  It  is  true  they  are  not;  but  they  are 
sufficiently  formidable  to  disorganise  the  mucous  membrane,  and  to 
perforate  the  stomach,  which  is  a  common  termination  of  those  latent 
forms  of  disease,  the  patients  hardly  fancying  themselves,  during 
the  whole  progress  of  the  affection,  which  will  last  for  years,  more 
than  slightly  indisposed.  I  have  traced  the  histories  of  some  of 


I    • 

I 

118  PARKER  ON  THE  STOMACH. 

these  cases  ending  by  softening  of  the  mucous  coat  and  perforation 
of  the  stomach. 

A  languid  state  of  circulation  does  not  preclude  the  existence  of 
chronic  inflammation  of  the  mucous  coat  of  the  stomach;  in  fact, 
it  accompanies  some  of  its  most  insidious,  uncontrollable,  and  fatal 
forms.  At  other  times  the  pulse  is  slightly  accelerated;  its  fre- 
quency increasing  towards  the  evening,  at  which  time  some  slight 
accession  of  fever  is  present,  sometimes  attended  with  cough  and 
flushings  of  the  cheek,  resembling  perfectly  the  character  of  hectic 
fever  depending  upon  disease  of  the  lung. 

In  a  third  form  of  disease  the  pulse  is  intermittent.  This  may 
be  present  during  the  whole  period  of  the  continuance  of  the  affec- 
tion of  the  stomach,  or  it  may  only  be  observed  when  the  inflamed 
condition  of  the  mucous  coat  assumes  a  greater  degree  of  severity, 
or  becomes  for  a  time  more  acute.  I  have  carefully  noted  the  cases 
of  several  patients,  who  are  subject  to  attacks  of  severe  inflamma- 
tory indigestion,  at  the  time  when  they  were  in  perfect  health,  and 
also  during  their  attacks  of  disease.  When  well,  nothing  could  be 
more  natural  than  the  state  of  the  heart;  when  suffering  from  sto- 
mach disease  the  disturbance  of  the  heart  and  circulating  system 
has  been  so  great  that  it  has  been  difficult,  even  knowing  the  pre- 
vious condition  of  these  organs,  not  to  suppose  that  their  functional 
disturbance  was  the  result  of  disease  in  the  organs  themselves. 
Where  this  disturbance  of  the  circulating  system  is  so  easily  occa- 
sioned, it  shows  a  predisposition  on  the  part  of  the  heart  to  become 
diseased;  and  the  continuance  of  stomach  disease,  either  in  a 
marked  or  latent  form,  would,  in  such  instances,  ultimately  induce 
disease  on  the  part  of  the  heart  itself.  I  shall  relate  the  histories 
of  three  cases  in  which  the  patients  died  from  diseases  of  the  heart 
where  no  physical  sign  of  such  disease  was,  at  the  commencement 
of  the  complaint,  in  existence,  and  in  which  the  primary  symptoms 
were  referable  to  the  stomach  alone. 


I. —  Of  the  association  of  Disease  of  the  Stomach  with  that  of 
the  Heart)  and  of  the  influence  which  the  former  exercises 
upon  the  progress  of  the  latter. 

CASE  8. — Disease  of  the  heart. — Fungoid  ulcerations  of  the  mitral  valve, 
with  inflammation  of  the  mucous  coat  of  the  stomach. — Great  relief  af- 
forded to  the  symptoms  of  the  disease  of  the  heart  by  mitigating  that  of 
the  stomach. 

A  lady,  aged  thirty-four,  was  placed  under  my  care  in  the  month 
of  September,  1835.  She  had  before  this  period  complained  occa- 
sionally of  palpitations,  but  nothing  more  had  been  remarked  in 
the  previous  history  of  her  disease. 

September  8th. — On  the  first  examination  of  the  patient  on  this 
day  I  noticed  the  pulsations  of  the  heart  to  be  tumultuous,  strong, 
irregular,  and  diffused  over  a  great  portion  of  the  left  side  of  the 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  HEART.          119 

chest.  When  -examined  by  auscultation  the  impulse  of  the  heart 
was  very  strong;  a  loud  "bruit  de  soufflet"  was  present,  which  was 
distinctly  heard  all  over  the  thorax.  The  pulse  unsteady,  flutter- 
ing, and  indistinct,  intermitting  every  third  or  fourth  beat,  and 
bearing  no  relation  to  the  systole  of  the  left  ventricle.  Orthopnoaa, 
cough,  frothy  expectoration  ;  legs  anasarcous  to  some  extent.  Pain 
and  tenderness  in  the  epigastrium,  with  constant  nausea  and  vomit- 
ing of  food;  tongue  dry  and  coated,  vividly  red  at  its  point  and 
edges.  These  symptoms  are  of  comparatively  recent  date,  during 
which  time  she  has  been  much  worse;  they  commenced  with  fla- 
tulence, pain,  and  distension  after  food,  then  the  palpitations  became 
more  distressing,  the  breathing  bad,  and  the  legs  anasarcous. 

September  14th. — Leeches  have  been  twice  applied  to  the  epi- 
gastrium, and  alkalies  with  morphia  have  been  administered.  The 
patient  describes  the  palpitations  to  be  much  less  distressing,  hardly 
feeling  them  all.  The  tongue  is  clean,  the  sickness  gone.  The 
contraction  of  the  ventricle  and  the  pulse  at  the  wrist  now  coincide, 
the  one  regularly  following  and  corresponding  with  the  other. 
The  heart's  action,  examined  by  auscultation,  is  still  remarkably 
strong,  still  diffused  over  a  lar^e  surface,  and  still  accompanied  by 
a  "bruit  de  soufflet,"  though  of  a  much  less  intense  character.  It 
is  evident  that  the  mitigation  of  the  symptoms  of  gastric  disease 
has  materially  allayed  the  irregularity  and  force  of  the  heart's 
action. 

September  20th. — At  the  present  date  no  gastric  symptoms  were 
present;  the  legs,  however,  were  very  dropsical,  the  breathing 
much  oppressed,  and  the  abdomen  large  and  full.  Small  doses  of 
elaterium  were  now  administered,  which  relieved  all  these  symp- 
toms materially,  but  distressed  the  stomach  very  much,  and  brought 
on  a  return  of  the  irregular  action  of  the  heart.  To  relieve  the 
symptoms  of  gastritis,  leeches  were  again  applied,  and  the  action  of 
the  heart  again  became  steady;  still  there  was  a  disposition  to  the 
return  of  the  anasarca,  with  an  oppressed  state  of  the  breathing. 
The  elaterium  always  agreed  with  the  patient,  and  relieved  the 
dropsical  symptoms  without  aggravating  the  state  of  the  heart, 
when  the  gastric  symptoms  were  kept  under  by  the  application  of 
leeches  to  the  epigastrium,  which  unloaded  the  congested  vessels  of 
the  mucous  membrane  of  the  stomach,  and  brought  it  into  a  state 
to  bear  the  impression  of  the  elaterium.  In  this  manner  the  pa- 
tient's state  was  rendered  comfortable  till  the  3d  of  October,  on  the 
morning  of  which  day  she  died  suddenly. 

Post-mortem  examination,  thirty  hours  after  death. — About  ten 
ounces  of  serum  were  effused  into  the  bag  of  the  pericardium;  large 
fibrinous  clots  in  all  the  cavities  of  the  heart.  Heart  hypertrophied 
to  some  extent;  membrane  of  the  left  ventricle  thickened  to  the 
consistence  of  thick  writing-paper,  easily  stripped  from  the  muscular 
structure  of  the  heart;  the  edges  of  the  mitral  valve  were  covered 
with  two  large,  dark-red,  fungoid  ulcerations.  The  stomach  was 
immensely  large,  extending  some  distance  below  the  umbilicus, 


120  PARKER  ON  THE  STOMACH. 

nearly  filling  the  whole  abdomen;  the  cardiac  portion  extremely 
thin,  the  mucous  membrane  had  here  almost  disappeared;  the 
pyloric  portion  of  a  uniform  bright-red  injection;  the  veins  of  the 
submucous  coat  much  distended;  here  and  there  black  patches, 
and  arborescence  on  the  mucous  coat  of  the  cardiac  extremity. 

Remarks. — This  is  a  very  instructive  case,  and  illustrates  many 
points  of  importance  in  the  co-existence  of  diseases  of  the  stomach 
with  those  of  the  heart.  The  nature  of  the  disease  of  the  heart, 
to  which  this  patient  fell  a  victim,  was  inflammation  of  the  lining 
membrane  of  the  left  ventricle,  and  its  terminations.  I  shall  adduce 
some  facts  in  the  history  of  the  next  case  which  lead  me  to  suppose 
that  this  inflammation,  however  frequently  it  may  derive  its  origin 
from  other  causes,  is  commonly  developed  from  continued  gastric 
irritation.  The  present  case  principally  illustrates  two  points  in 
diseases  of  the  heart — the  state  of  the  stomach  during  the  progress 
of  such  diseases,  the  influence  this  exercises  upon  the  heart's  action, 
and  the  effects  of  remedies  administered  to  relieve  any  particular 
state  which  may  depend  upon  the  disease  of  the  heart,  or  to  which 
it  may  give  rise  during  its  continuance,  such  as  the  anasarca,  &c., 
in  the  present  instance.  If  we  enquire  into  the  pathologic  condi- 
tion of  the  stomach,  in  the  first  place,  we  find  it  to  be  one  of  pure 
inflammation,  varying  in  the  effects  which  this  has  upon  the  sto- 
mach according  to  the  irritability  of  the  patient  in  whom  the  dis- 
ease occurs.  It  is  true  that  many  of  the  changes  which  we  find  in 
the  stomach,  during  diseases  of  the  heart,  are  the  consequences  of 
mere  congestion,  owing  to  the  mechanical  impediment  offered  by 
the  embarassed  state  of  the  heart  to  the  free  return  of  blood  from 
the  venous  system  of  the  abdomen ;  but,  at  the  same  time  that  we 
find  congestion  in  one  part  of  the  stomach,  we  find  a  pure  inflam- 
matory state  existing  in  others.  The  mere  appearances  of  redness 
observed  in  the  stomach  after  death  in  diseases  of  the  heart  are  not 
enough,  perhaps,  to  enable  us  to  determine  of  which  exact  character 
these  changes  may  be,  "since,"  says  Andral,  "we  are  convinced 
that  this  congestion  may  assume  most  of  the  shades  of  inflamma- 
tory redness."  Broussais  distinguishes  congestion  from  inflamma- 
tion in  these  states.  If  the  affection  be  of  an  inflammatory  kind 
the  redness  is  not  uniform,  but  irregular,  vivid  in  points  or  arborU 
sations,  &c.,  and  commonly  combined  with  some  of  the  conse- 
quences of  inflammation,  with  induration,  softening,  or  nlceration.1 
If  we  find  during  life  vomiting,  flatulence,  uneasiness,  weight,  and 
tenderness  in  the  epigastrium,  we  maybe  sure  that  gastritis  is  asso- 
ciated with  the  disease  of  the  heart,  and  the  continuance  of  the 
former,  will  only  hasten  the  termination  of  the  latter,  and  give  rise 
to  many  symptoms  which  would  otherwise  be  absent,  caused  by  the 
additional  embarrassment  the  disease  of  the  stomach  produces  in 
the  heart's  action.  We  have  a  remarkable  instance,  in  the  case 
just  detailed,  of  the  effect  which  the  mitigation  or  increase  of  the 

1  Cours  de  Pathologie,  &c.,  tome  iii.,  p.  125,  126. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  HEART.         121 

gastric  symptoms  has  upon' the  heart's  action.  We  find  the  pulse 
at  the  wrist  become  steady  and  lose  its  intermission  when  the  gas- 
tritis subsides,  and  return  with  the  disturbance  of  the  stomach.  In 
many  cases  we  shall  find  also  anasarca  and  great  dispnoea  coming 
on  during  diseases  of  the  heart,  associated  with  gastritis,  which 
symptoms  are  commonly  attributed  to  the  disease  of  the  heart,  to 
which  they  cartainly  belong,  but  the  state  of  the  heart  which  gives 
rise  to  these  symptoms  is  caused  by  the  irritation  to  which  it  is 
subjected  from  the  disease  in  the  stomach.  Mitigate  or  cure  this, 
and  we  shall  find  the  aggravated  symptoms  attendant  upon  disease 
of  the  heart  disappear,  and  persons  sometimes  cease  to  feel  they 
bear  such  disease  about  them.1  A  point  of  great  importance,  in  the 
history  of  the  last  case,  refers  to  the  effects  of  remedies  given  to 
relieve  the  symptoms  accompanying,  or  produced  by,  the  heart-dis- 
ease, such  as  anasarca,  or  the  threatenings  of  effusion  into  the 
peritoneum,  pleura,  or  pericardium.  Thus,  we  see  the  use  of  the 
elaterium  in  the  preceding  case  aggravate  the  symptoms,  by  in- 
creasing the  irregularity  of  the  heart's  action;  this  arises  from  the 
effects  this  medicine  produces  in  the  stomach,  adding  to  the  irritation 
already  existing  in  this  organ.  We  observe  this  medicine  to  pro- 
duce the  good  effects  generally  attributed  to  it.  in  dropsy,  whilst  the 
gastric  irritation  is  subdued  by  the  local  depletion  from  the  epigas- 
trium. It  is  a  common  circumstance,  that  stimulating  diuretic  and 
purgative  medicines,  given  to  excite  the  kidneys  or  bowels,  during 
various  dropsical  states,  which  accompany  diseased  heart,  produce 
a  totally  opposite  effect  to  that  which  they  are  intended.  We  ob- 
serve sickness  produced,  and  the  urine,  already  scanty,  actually 
becomes  more  so,  under  the  use  of  these  remedies,  whilst  at  the 
same  time  the  dropsical  symptoms  increase.  On  the  other  hand, 
leeches  to  the  epigastrium  (if  the  symptoms  are  urgent),  and  reme- 
dies calculated  to  allay  the  gastric  irritation,  at  once  reduce  the 
dropsical  symptoms  and  increase  the  urinary  secretion.  The  evils 
which  are  frequently  attributed  to  the  disease  of  the  heart,  very 

'In  a  considerable  number  of  cases,  irritation  of  the  stomach  or  of  the 
intestines  is  announced  only  by  local'symptoms  rather  obscure;  but  this 
irritation  reacts  sympathetically  on  the  heart,  and  the  symptoms  arising  from 
the  affection  of  the  latter  are  very  much  aggravated.  Thus  its  beats  acquire 
unusual  frequency,  they  become  irregular  and  tumultuous;  the  difficulty  of 
breathing  increases:  these  symptoms,  again,  acquire  for  a  time  a  higher 
degree  of  intensity  every  time  that  food  is  taken  into  the  stomach.  Among 
other  instances,  we  saw  an  individual  in  whom  the  indigestion  ef  simple 
drinks  was  immediately  followed  by  difficulty  of  breathing,  so  that  lying 
down  was  impossible;  and  for  about  two  hours  the  patient  was,  as  it  were, 
threatened  with  asphyxia.  At  the  same  time  that,  under  the  influence  of 
the  gastro-intestinal  inflammation,  the  local  symptoms  of  heart-disease  are 
increased  in  severity,  we  also  see  dropsy  either  manifest  itself,  for  the 
first  time,  consecutively  to  the  increase  in  the  disturbance  of  the  venous 
circulation,  or  become  increased  if  it  did  exist  before,  or,  finally,  if,  after 
having  already  existed,  it  had  disappeared.  These  different  symptoms 
become  aggravated  as  long  as  the  affection  of  the  digestive  tube  exists,  and 
they  amend  along  with  il.—Andral. 


122  PARKER  OF  THE  STOMACH. 

commonly  arise  from  inflammatory  irritation  of  the  stomach,  when 
affections  of  the  former  organ  produce,  as  in  most  instances  they 
do,  disease  of  the  inflammatory  kind  in  the  latter.  I  may  observe, 
in  concluding  these  remarks,  that  in  diseases  of  the  heart,  whether 
acute  or  chronic,  the  state  of  the  stomach  should  never  he  overlooked, 
since  irritation,  secondarily  set  up  in  it,  most  materially  adds  to  the 
severity  of  the  primary  disease.  Even  during  acute  affections  of 
the  heart  or  its  membranes,  we  sometimes  observe  this  state  of  the 
stomach  present,  and  the  patients  chiefly  complaining  of  epigastric 
pain  and  tenderness,  accompanied  by  vomiting. 

A  youth,  aged  twenty,  subsequent  to  rheumatism,  was  seized 
with  an  acute  attack  of  pericarditis.  He  was  relieved  by  general 
bleeding,  and  leeches  applied  freely  over  the  cardiac  region  ;  still, 
however,  the  symptoms  did  not  entirely  give  way.  During  the 
progress  of  his  disease,  he  had  complained  of  a  constant  pain  in  the 
epigastric  region,  which  was  highly  sensible  to  pressure  ;  the  sto- 
mach would  retain  nothing.  Leeches  were  now  applied  over  this 
region  ;  the  vomiting  ceased,  the  action  of  the  heart  became  steady 
and  a  perfect  convalescence  was  speedily  established. 

Attacks  of  acute  gastritis  sometimes  supervene  in  persons  who 
carry  about  them  organic  affections  of  the  heart.  A  lady,  aged 
fifty-four,  had  suffered  from  palpitations  for  about  ten  years,  ac- 
companied by  great  dyspnoea  and  occasional  faintness.  The  pulse 
at  the  wrist  was  merely  an  unsteady  tremulous  motion  of  the 
artery  in  which  nothing  like  distinct  pulsation  could  be  detected 
The  action  of  the  heart  was  diffused  over  a  great  extent  of  surface, 
the  hand  laid  over  it  detected  no  impulse,  a  mere  tremor  was  all  that 
was  perceptible ;  the  stethoscope  indicated  an  indistinct  undu- 
lation, in  which  all  the  regular  rhythm  of  the  heart  was  lost.  Occa- 
sionally this  patient  was  seized  with  acute  pain  in  the  epigastrium 
which  was  increased  to  agony  by  pressure.  The  stomach  rejected 
in  a  sour  and  bitter  state,  every  thing  taken  into  it.  These  symp- 
toms recurred,  without  any  marked  cause,  at  intervals  of  some 
months,  and  were  subdued  by  local  depletion  from  the  region  of  the 
stomach. 

CASE  9. — A  second  lady,  aged  thirty-five,  had  presented  all  the 
symptoms  of  an   organic   affection  of  the  heart  for   five   years 
These  consisted  in  an  unusually  strong  impulse  of  the  organ,  ex- 
tended over  a  great  surface,  occasional  irregularity  of  its  rhythm 
accompanied  by  a  strong  "  bruit  de  soufflet,"  the  pulse  intermitting 
always  at  intervals  of  five  or  six  beats.     Every  six  weeks  or  two 
months,  distressing  attacks  of  vomiting  set  in,  accompanied  by  great 
pain  and  tenderness  in  the  epigastrium.     During  the  continuance 
of  the  gastric  symptoms,  the  pulse  at  the  wrist  was  indistinct 
merely  an  unsteady  fluttering,  whilst  the  action  of  the  heart  was 
strong  and  tumultuous  ;  auscultation  detected  nothing  but  a  pow 
erful  fluttering  motion,  in  which  all  traces  of  the  heart's  natura 
action  were  lost.     The  patient,  during  the  continuance  of  the  gas 
trie  symptoms,  could  never  rise  from  the  bed,  the  faintness  occa 


INFLUENCE  OP  ITS  MORBID  STATES  ON  THE  HEART. 


123 


sioned  by  the  violent  disturbance  of  the  heart's  action  was  so  great. 
When  free  from  the  stomach  affection  she  was  comparatively  well. 
After  this  state  had  continued  for  four  or  five  years,  with  little  vari- 
ation, symptoms  of  a  regular  tertian  intermittent  fever  set  in,  accom- 
panied by  constant  gastric  derangement,  pain  and  tenderness  in  the 
epigastrium,  with  occasional  vomiting;  anasarca  succeeded,  and  the 
patient  suddenly  died,  apparently  from  effusion  into  the  pericardium, 
for  d ul ness  on  percussion  to  great  extent  in  the  region  of  the  heart 
was  detected  after  death,  which  had  not  previously  existed.  Per- 
mission to  examine  the  body  was  refused. 

This  case  is  another  example  of  the  influence  which  disease  of 
the  stomach  exercises  over  that  of  the  heart,  in  aggravating  the 
symptoms  of  the  latter  and  accelerating  their  termination.  These 
coincident  affections  of  the  heart  and  stomach  afe  a  circle  of  mor- 
bid actions,  in  which  it  is  difficult  to  fix  a  point  of  commencement ; 
the  disease  of  the  stomach  irritating  the  heart,  and  the  affection  of 
the  latter  causing  congestions  of  the  former,  and  predisposing  it  to 
inflammatory  action.  I  have  often  found  the  veins  of  the  sub- 
mucous  coat  of  the  stomach,  in  diseases  of  the  heart,  as  full  of 
coagulated  blood  as  though  they  had  been  filled  with  injection.  In 
the  case  just  related,  as  in  that  which  precedes  it,  we  notice  the 
increased  severity  of  the  affection  of  the  heart  taking  place  when- 
ever the  symptoms  of  gastritis  occurred  ;  though,  doubtless,  the 
predisposition  to  disease  in  the  stomach  is  occasioned  by  that  of  the 
heart,  retaining  in  the  coats  of  this  organ,  as  I  have  previously 
stated,  a  greater  quantity  of  blood  than  is  necessary  to  the  fulfilment 
of  its  functions. 

CASS  10.— Gastritis— Softening  of  the  heart. 

An  elderly  female,  aged  sixty,  came  under  my  care,  who  had  for 
many  months  had  great  difficulty  of  breathing,  with  daily  vomiting 
of  food. 

When  I  first  saw  her  on  the  8th  of  December,  1836,  she  pre- 
sented the  following  state :— pallid  countenance  with  livid  lips, 
legs  anasarcous  to  a  considerable  extent ;  the  breathing  very  diffi- 
cult. She  could  not  take  any  kind  of  food  without  its  producing 
pain  and  vomiting;  the  epigastrium  was  painful,  and  very  sensible 
to  slight  pressure ;  the  pulse  at  the  wrist  a  mere  tremulous  motion 
of  the  artery,  hardly  to  be  called  pulsation ;  the  heart,  examined 
by  auscultation,  presented  merely  a  tremulous  undulation,  but  no 
distinct  sounds.  She  died  suddenly,  a  few  days  after  my  first  visit 
to  her. 

Post-mortem  examination^  twenty-four  hours  after  death. — 
The  stomach  was  one  uniform  mass  of  vividly  red  injection  in  its 
pyloric  half;  the  cardiac  portion  black,  with  blood  conjested  in 
numerous  patches ;  the  veins  of  the  submucous  coat  distended  with 
blood.  The  spleen,  four  times  its  natural  size,  full  of  black  blood  ; 
the  vasa  brevia  as  much  distended  with  this  fluid  as  though  they 


124  PARKER  ON  THE  STOMACH. 

had  been  filled  with  injection.  The  liver  greatly  elarged,  pale,  and 
hard.  Heart  so  soft  as  almost  to  drop  to  pieces  in  the  fingers  ;  its 
muscular  structure  very  pale;  it  might  be  rubbed  away  to  a  pulp 
between  the  thumb  and  finger. 

Remarks.-^This  is  a  third  example  of  that  form  of  irregular 
action  of  the  heart  which  stimulates  valvular  disease  of  that  organ, 
and  which  appears  to  have  been  produced  and  kept  up  by  continued 
gastric  irritation.  In  chronic  gastric  diseases,  which  have  con- 
tinued for  a  number  of  years,  it  is  common  to  find  a  softened  slate 
of  the  pareriehymatous  organs,  generally  similar  to  that  which,  in 
this  instance,  affected  the  substance  of  the  heart.  This  softening  is 
very  commonly  found  in  the  liver,  to  such  an  extent  that  it  may  be 
rubbed  away  easily  between  the  fingers.  I  have  remarked  this 
condition  of  structure  in  the  spleen,  the  kidneys,  the  heart  and  the 
liver  to  be  a  common  attendant  on  that  cachetic  state  into  which 
patients  with  long-continued  chronic  gastritis  sometimes  fall. 

In  the  present  instance,  we  notice  it  affecting  the  heart,  the  irre- 
gularity in  the  actions  of  which  was  evidently  dependent  on  the 
softene  .1  state  of  its  walls,  they  not  being  sufficiently  powerful  to 
cause  a  proper  contraction  of  the  ventricle ;  hence  the  peculiar 
condition  of  the  pulse. 

II. — General  history  of  the  influence  of  the  Stomach  upon  the 
Heart)  and  of  the  state  of  the  Stomach  in  diseases  of  the  Heart. 

The  first  effects  we  shall  notice  of  the  influence  of  the  stomach 
upon  the  heart  are  certain  irregularities  in  the  action  of  the  latter 
organ,  which  are  independent  of  any  appreciable  alteration  in  its 
structure,  either  as  regards  the  consistence  of  its  walls,  the  state  of 
its  valves,  or  its  investing  or  lining  membranes.  These  irregularities 
consist  in  an  unusual  frequency  of  its  pulsations,  or  alterations  of 
their  character,  in  which  the  regular  and  natural  rhythm  of  the  heart 
is  lost,  the  contractions  of  its  cavities  do  not  follow  each  other  in 
their  customary  and  due  succession,  and  the  pulse  consequently  in- 
termits. We  find  many  persons  in  whom  both  these  states  of  the 
heart's  action  occur,  without  there  being  any  organic  affection  of 
the  heart  itself,  or  even  an  approach  to  it. 

The  states  of  stomach  which  produce  these  irregularities  of  the 
heart's  action  are  various,  but  may  generally  be  referred  to  three 
classes  ;  1.  A  state  of  mere  hyperemia,  or  congestion  of  the  mucous 
coat ;  2.  A  confirmed  inflammatory  condition  ;  or,  3.  A  morbid 
state  of  its  sensibility.  In  some  instances,  as  in  case  1,  we  find  an 
unusual  degree  of  frequency  in  the  heart's  action  after  taking  a 
moderate  meal,  which  continues  as  long  as  the  period  of  digestion 
lasts.  I  have  occasionally  been  consulted  by  a  gentleman,  in  whom, 
the  pulsations  rise  to  as  many  as  a  hundred  and  ten  or  twenty  beats 
in  a  minute.  No  fever  accompanies  this  state:  as  long  as  the 
symptoms  of  stomach  derangement  are  urgent,  the  action  of  the 
heart  keeps  up.  This  is  relieved  as  the  stomach  becomes  healthy ; 
but  after  its  return  to  an  apparently  healthy  state,  the  action  of  the 


INFLUENCE  OF  ITS  MOU13ID  STATES  ON  THE  HEART.         125 

heart  is  again  excited  by  food  to  almost  its  primitive  frequency, 
which  continues  for  some  time  after  all  the  symptoms  connected 
with  the  stomach  have  disappeared,  excepting,  perhaps,  a  slight 
decree  of  flatulence.  This  state  of  the  heart  is  frequently  accom- 
panied by  considerable  tenderness,  heat  and  beating  in  the  epigas- 
trium, and  in  such  cases  local  depletion  from  this  region  is  produc- 
tive of  great  benefit.  Occasionally,  however,  it  happens,  that  the 
irritability  of  the  heart  continues,  after  eating,  for  some  time,  when 
the  inflammatory  or  hyperemic  conditions  of  the  stomach,  which 
accompany  or  produce  it,  have  subsided:  in  such  instances  I  have 
found  the  various  preparations  of  iron  of  great  service,  combining 
them  with  anti-spasmodic,  aperient,  or  sedative  remedies,  according 
to  the  circumstances  of  the  case.  The  remedies  should  be  suited 
to  the- nature  of  the  stomach  affection,  upon  which  the  excited 
action  of  the  heart  appears  to  depend.  If  the  inflammatory  symp- 
toms are  well  marked,  we  must  have  recourse  to  a  moderate  deple- 
tion from  the  epigastrium;  if  constipation,  with  flatulence  and  pain 
after  food,  a  combination  of  the  pil.  aloes  comp.  with  the  pil.  hyd., 
or  pil.  rhaei  comp.  with  the  galbani  comp.,  and  minute  doses  of  the 
muriate  of  morphia,  will  be  of  service,  taking  at  the  same  time  the 
hydrocyanic  acid;  the  latter  remedy  is  of  great  use,  given  in  the 
mist,  cretse,  if  diarrhoBa  be  present  instead  of  constipation,  or  when 
great  irritability  of  the  stomach,  accompanied  by  acidity,  are  the 
prominent  symptoms. 

In  a  second  form  of  sympathetic  irritation  of  the  heart,  we  find 
irregularities  in  its  actions,  which  are  of  various  kinds.  These 
irregularities  display  themselves  in  intermissions  of  the  pulse,  and 
tumultuous,  hurried,  and  confused  beating.  We  find  that,  in 
some  persons,  the  pulse  intermits  every  four  or  five  beats,  during 
the  accession  of  an  attack  of  stomach  derangement,  whilst,  during 
the  freedom  from  such  attacks,  the  action  of  the  heart  is  perfectly 
natural.  In  the  cases  of  two  ladies,  who  occasionally  consult  me, 
the  heart  presents  these  forms  of  intermission.  In  one  of  these 
cases,  the  pain  after  food,  with  beating,  heat,  and  tenderness  in  the 
epigastrium,  is  always  accompanied  by  an  intermittent  pulse:  when 
well,  the  heart  does  not  present  the  slightest  irregularity  in  its 
beats,  or  any  increase  of  force,  in  the  second  instance,  the  sto- 
mach affection  is  not  so  well  marked  ;  but  the  intermittent  pulse  is 
a  certain  symptom  that  the  stomach  is  affected,  and,  consequently, 
by  attention  to  the  latter  organ,  the  heart  resumes  its  natural  and 
accustomed  action.  Not  the  slightest  physical  sign  of  disease  can 
be  detected  in  the  heart  in  either  of  these  cases.  I  have  before 
said,  that  the  symptoms  of  disease  in  the  stomach  are  sometimes 
to  be  found  in  the  heart:  the  last  case  to  which  I  have  alluded  is 
a  remarkable  instance  of  this. 

The  two  forms  of  intermittent  pulsation,  which  I  have  noticed, 
are  common,  and  doubtless  depend  upon  a  morbid  condition  of  the 
sensibility  of  the  epigastric  nervous  centre,  sympathetically  affect- 
ing the  heart,  and  in  such  instances  there  is  no  reason  to  suspect 


126  PARKER  ON  THE  STOMACH. 

that  any  affection  of  this  viscus  is  in  existence,  more  than  a  mere 
derangement  of  the  nervous  system  supplying  it.  "In  a  crowd  of 
diseases,1'  observes  Andral,  "in  those  particularly  where  the  action 
of  the  nervous  centres  is  more  or  less  modified,  the  heart  presents 
irregularities  and  well-marked  intermissions."  I  have  shown  some 
varieties  of  these  variations,  as  they  affect  the  arterial  circulation, 
at  the  commencement,  and  during  the  progress  of  fevers,  which 
depend  altogether  on  a  modification  of  the  sensibility  of  the  nerves 
of  the  stomach  and  epigastrium.  There  are,  however,  sometimes 
cases  occurring,  in  which  all  the  tissues  entering  into  the  composi- 
tion of  the  heart  remaining  healthy,  the  irregularities  of  its  action 
heard  under  the  stethoscope,  and  the  character  of  the  pulse  at  the 
wrist,  precisely  resemble  those  of  organic  disease.  The  second 
case  of  the  preceding  chapter,  and  that  recorded  by  Cruveilhier 
and  quoted  in  the  notes  to  my  own  case,  are  examples  of  this  form 
of  disease.  In  both  these  instances,  no  disease  was  detected  in  the 
heart;  even  the  state  of  its  nutrition,  the  consistence  of  its  walls, 
presented  no  appreciable  morbid  state. 

In  other  instances,  as  in  case  10,  these  tumultuous  and  irregu- 
lar actions,  and  intermitttent  pulsations,  coincide  with  an  alteration 
in  the  structure  of  the  walls  of  the  heart,  evidently  produced  by 
long-continued  gastric  disease.  In  acute  and  chronic  gastric  and 
gastro-enteric  diseases  there  is,  as  I  have  before  said,  a  peculiar 
tendency  to  the  softening  of  some  organs,  particularly  of  the  liver 
and  heart:  if  we  turn  to  the  chapter  on  the  Diseases  of  the  Liver 
we  shall  remark  many  instances  of  this  softened  state  of  the  or- 
gan. "In  the  conditions  of  which  we  are  speaking,"  observes 
Broussais,1  "the  heart  is  sometimes  so  friable  that  the  finger  pene- 
trates its  walls  with  ease."  In  the  subject  of  the  tenth  case,  we 
noted  that  the  substance  of  the  heart  was  so  soft,  that  we  might 
rub  it  to  a  fleshy  pulp  between  the  fingers.  It  is  most  likely,  that 
this  state  of  softening  is  the  result  of  a  protracted  irritation  in  the 
heart,  marked,  in  the  first  instance,  by  the  irregularities  observed 
in  case  2,  which,  after  the  continuance  of  such  irritation  for  a  cer- 
tain period,  terminates  in  the  softening  of  the  organ,  as  exhibited  in 
case  10.  In  this  manner  do  continued  irritations  ultimately  pro- 
duce alterations  of  the  structure  of  organs,  in  which  such  irri- 
tations are  set  up ;  and,  in  the  cases  before  us,  these  irregularities 
in  the  pulsations  and  action  of  the  heart,  are  the  result  of  com- 
plaint first  seated  in  the  mucous  surfaces  of  the  stomach. 

When  actual  disease  of  the  heart  is  in  existence,  manifested 
by  the  most  unequivocal  physical  signs,  we  commonly  find  the 
state  of  the  heart's  action  increasingly  embarrassed,  under  the  ad- 
ditional irritation  produced  by  the  occurrence  of  any  morbid  con- 
dition of  the  mucous  membrane  of  the  stomach,  set  up  during  the 
progress  of  the  disease  of  the  heart:  the  seventh  case  is  a  remark- 

l(<Etat  du  OoB-ur,  &c.,  dans  les  Gastro  ententes  aigues."— Cours  de 
Pathologie,  Le9on  27me. 


INFLUENCE    OF    ITS    MORBID    STATES    ON    THE    HEART.       127 

able  example  of  this  fact.  The  knowledge  of  this  is  of  extreme 
importance  in  the  treatment  of  all  diseases  of  this  character.  The 
detail  of  the  seventh  case  and  the  notes  appended  to  it  are  well 
worthy  of  attention.  We  sometimes  ohserve  the  symptoms  of 
distress  produced  by  the  action  of  a  diseased  heart,  under  the  in- 
fluence of  stomach  irritation,  mitigated  or  entirely  removed  by  the 
relief  or  cure  of  such  irritation.  A  gentleman,  of  middle  age, 
who  had  suffered  severely  from  attacks  of  acute  rheumatism,  com- 
plained to  me  of  distressing  palpitation,  which  incapacitated  him 
for  exertion,  and  produced  hurried  breathing  and  a  sense  of  suffo- 
cation. On  examining  the  heart  its  impulse  was  found  much 
stronger  than  in  the  natural  state,  at  the  same  time  a  loud  "bruit  de 
souffiet"  was  present.  With  these  physical  signs  of  disease  of  the 
heart  the  digestive  powers  were  seriously  disturbed;  he  had  pain 
and  tenderness  in  the  epigastrium,  nausea,  distressing  flatulence, 
and  distension  after  food,  with  a  full,  hard  pulse,  a  tongue  dry  and 
red,  on  which  the  papillas  were  unusually  red  and  developed.  By 
removing  the  gastric  irritation  under  which  he  labored,  the  palpi- 
tations and  oppressed  breathing  disappeared;  and  although  the 
state  of  the  heart  remained  the  same,  as  far  as  the  physical  signs 
of  disease  it  exhibited  were  concerned,  still  all  irregular  action 
subsided,  and  the  patient  felt  himself  perfectly  well. 

When  any  impediment  is  offered  to  the  free  passage  of  blood 
through  the  heart,  either  from  frequent  irregularities  in  the  action 
of  this  organ  without  any  apparent  disease,  or  from  disease  either 
of  the  acute  or  chronic  kind,  the  mucous  membrane  of  the  stomach 
becomes  the  seat  of  certain  morbid  changes,  which  are  dependent 
upon  the  mechanical  obstacle  to  the  circulation,  presented  by  the 
disease  of  the  heart.  These  may  consist  in  mere  redness,  the  re- 
sult of  congestion,  or  pure  inflammatory  affections,  in  which  there 
are  marked  changes  in  the  colour  and  consistence  of  the  gastric 
mucous  membrane1. 

1  The  same  views  are  supported  by  Andral  and  Broussais. — "  From  the 
mere  stagnation  of  blood  in  the  mucous  membrane  of  the  stomach,  which 
is  merely  mechanical,  there  results  not  only  a  red  colouring  of  their  tissue, 
appreciable  after  death,  but,  consecutively  to  this  accumulation,  there  are 
also  seen  to  arise  real  alterations  of  texture  and  remarkable  symptoms. 
*  *  *  Rut  from  the  circumstance  of  the  intestinal  redness  in  aneuris- 
matic  patients  being  most  frequently  the  mere  mechanical  results  of  em- 
barrassment in  the  venous  circulation,  it  would  be  a  serious  error  to  con- 
clude that,  every  time  this  redness  is  observed,  it  recognises  a  similar 
cause.  Often  enough  it  seems  to  depend  on  a  real  inflammatory  process, 
to  which,  in  some  cases,  the  venous  congestion  probably  predisposes." — 
Clinique  Medicale,  by  Spillan,  p.  253,  254.  "  This  redness  is  not  the  same  in 
the  two  cases  of  mere  passive  congestion  and  inflammation.  If  the  patient 
has  died  free  from  inflammation  in  the  organs  of  digestion,  the  redness  is 
uniform,  and  accompanied  by  a  fulness  of  the  veins,  resembling  an  injected 
state  o  tL"m.  If,  on  the  contrary,  a  true  inflammation  has  succeeded  to  the 
congf  iij:-,  which  commonly  happens  when  a  due  regard  has  not  been  paid 
to  the  sensibilities  of  the  stomach  and  the  state  of  the  tongue,  and  strong 
diuretics  have  been  exhibited,  the  redness  is  not  uniform;  but  irregular, 


128  PARKER  ON  THE  STOMACH. 

The  congestion  or  stagnation  of  blood  alone,  in  the  veins  and 
membranes  of  the  stomach,  is  sufficient,  without  any  other  cause, 
to  disturb  its  functions,  to  render  the  process  of  digestion  laborious. 
and  to  produce  sympathetic  affections  in  other  organs  of  the  body; 
but  the  disturbance  of  the  digestive  process,  and  the  sympathetic 
affections  which  accompany  it,  are  commonly  more  severe  when 
other  changes,  resulting  from  inflammation,  have  been  produced. 
It  is  most  probable  that  the  first  morbid  condition,  produced  in  the 
coats  of  the  stomach  by  diseases  of  the  heart,  is  an  accumulation  of 
blood  in  its  veins  and  mucous  membrane,  the  result  of  a  mechani- 
cal obstacle  to  the  passage  of  this  fluid  through  the  heart ;  the  con- 
stant presence  of  food  and  stimulating  medicines,  upon  a  mem- 
brane already  irritated,  convert  what  was  at  first  a  mere  congestion 
into  inflammation.  The  effects  of  elaterium,  upon  the  subject  of 
the  seventh  case,  strikingly  corroborate  this  view.  In  that  case, 
when  the  vessels  and  coats  of  the  stomach  were  unloaded  by 
leeches  applied  to  the  epigastrium,  before  the  administration  of  the 
elaterium,  this  remedy  did  not  distress  the  stomach,  but  produced 
the  happiest  effects  in  relieving  the  dropsy.  If  the  remedy  were 
given,  without  previously  leeching  the  stomach,  it  irritated  this 
organ,  produced  vomiting,  and  added  to  the  patient's  distress, 
instead  of  relieving  her.1 

Andral  has  remarked  the  frequent  inutility  and  hurtfulness  of 
digitalis,  in  diseases  of  the  heart,  that  it  frequently  excites  arterial 
action  arid  produces  sickness,  instead  of  controlling  and  depressing 
the  pulse.  This  arises  from  its  being  exhibited  upon  a  mem- 
brane, already  irritated  by  congestion  or  inflammation. 


CHAPTER  XL 

ON  THE  INFLUENCE  OF  MORBID  STATES  OF  THE  STOMACH, 
UPON  THE  ORIGIN,  PROGRESS,  AND  TERMINATION  OF  DIS- 
EASES OF  THE  LUNGS. 

PARTICULAR  CASES. 

CASE  1. — Incessant  cough,  depending  on  inflammation  of  the  stomach,  cured 
with  the  latter  affection. 

A  healthy  little  boy,  aged  seven,  was  seized  with  shivering  and 
the  ordinary  symptoms  of  fever,  during  the  first  few  days  of  which 

vivid,  deep-coloured,  pointed,  arborescent,  dispersed  over  the  surface  of  the 
mucous  membrane,  and  combined  with  other  lesions,  proper  to  inflamma- 
tion, as  induration,  softening,  or  ulceration." — Broussais,  Cours  de  Patholo- 
gic et  Therapeutique  generales,  Je9on  67,  t.  Hi.,  p.  135,  136.  Paris,  1834. 

'"The  unseasonable  exhibition  of  different  stimulating  medicines,  given 
for  the  purpose  of  exciting  perspiration,  urine,  or  stools." — Andral. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.    129 

no  particular  symptoms  or  complications  were  remarked.  At  the 
end  of  this  period  a  short  dry  cough  made  its  appearance,  which 
increased  to  such  an  extent,  that  the  young  patient  was  never  ten 
minutes  free,  night  or  day,  from  its  constant  irritation,  for  many 
days.  It  was  in  its  character  short  and  dry,  unaccompanied  by 
expectoration.  Dunns:  its  progress  he  was  reduced  to  an  extreme 
degree  of  emaciation.  The  most  careful  and  repeated  examination 
of  the  chest  detected  no  lesion  in  the  lungs,  their  investing  or  lining 
membranes.  Once  or  twice  in  the  day  there  was  slight  sickness ; 
the  tongue  was  intensely  red,  its  papillse  shining,  elevated,  and 
much  developed  ;  the  bowels  alternately  confined  and  relaxed  ;  the 
stools  green  as  grass  and  scanty.  The  skin  was  hot  and  dry.  the 
pulse  one  hundred  and  thirty  :  some  slight  uneasiness  was  experi- 
enced in  the  epigastric  region,  when  examined  by  pressure,  and  the 
patient  referred  us  to  this  point  as  the  seat  of  his  pain.  On  reflect- 
ing upon  this  case,  I  was  disposed  to  consider  the  affection  of  the 
chest  as  a  purely  functional  disease,  depending  upon  an  acute  form 
of  inflammation  of  the  mucous  membrane  of  the  stomach,  and  pro- 
bably of  the  duodenum.  Eight  leeches  were  applied  over  the  epi- 
gastrium, and  the  patient  took  four  grains  of  the  hyd.  c.  creta  every 
six  hours,  and  in  the  intervals  a  drop  of  hydrocyanic  acid  in  some 
almond  emulsion.  The  plan  was  pursued  for  two  days  without 
much  benefit,  the  patient  still  complaining  of  the  stomach,  the  sick- 
ness and  green  stools  continuing.  Convinced  that  I  was  accurate 
in  my  diagnosis,  the  plan  was  still  continued;  leeches  were  applied 
daily  in  smaller  quantities,  and  the  same  medicines  were  persevered 
in.  At  the  end  of  the  fifth  day  the  patient  was  perfectly  convales- 
cent, although  the  disease  had  continued  three  weeks,  and  the  child 
was  reduced  to  an  extreme  degree  of  marasmus. 

Remarks. — This  is  an  example  of  a  functional  affection  of  the 
lungs,  under  the  form  of  cough,  produced  and  kept  up  by  gastric 
inflammation.  The  features  of  the  affection  of  the  lungs,  however, 
were  so  prominent,  that  the  stomach  disease  was,  in  some  measure, 
masked  by  it.  The  cough  was  incessant,  and  allowed  the  sufferer 
no  rest ;  he  was  actually  exhausted  by  its  constant  irritation,  yet 
no  physical  sign  of  disease  of  the  lung  could  be  detected.  Here 
we  experience  the  value  of  auscultation,  for,  doubtless,  had  the 
remedies  been  directed  to  the  relief  of  the  pulmonary  affection,  the 
patient  would  have  been  lost.  If  we  take  into  review  the  group  of 
other  symptoms,  we  shall  find  that  they  point  to  the  digestive  organs 
as  the  seat  of  disease.  The  state  of  the  tongue,  the  sickness,  the 
alternate  constipation  and  diarrhoea,  the  character  of  the  evacuations 
when  passed,  with  the  epigastric  pain  and  tenderness,  leave  us  no 
doubt  as  to  the  seat  of  complaint ;  the  absence,  also,  of  physical 
signs  of  disease  in  the  lung,  lead  us  to  look  upon  that  affection  as 
purely  sympathetic.  The  success  of  the  plan  of  treatment  adopted 
confirms  the  diagnosis  ;  we  have  the  satisfaction  to  observe  the 
patient  recover  under  its  persevering  use. 

12— a  park  9 


130  PARKER  ON  THE  STOMACH. 

Case  2. — Cough  dependent  upon  chronic  Inflammation  of  the  Stomach. — 
Cure  with  the  Stomach  Disease.1 

A  young  man,  twenty-six  years  of  age,  had  been  troubled  for 
four  months  with  a  dry,  irritating  cough,  which  had  been  in  vain 
treated  by  the  usual  pectoral  remedies:  these  had,  in  fact,  rather 
increased,  than  mitigated,  the  disease.     Suddenly  he  was  seized 
with   general   fever,  accompanied   by  lassitude,  headach,  nausea, 
and  vomiting;  at  the  same  time  the  cough  became  much  more 
frequent  and  distressing.     The  respiration  was  only  slightly  acce- 
lerated in  the  intervals  of  the  fits  of  coughing  ;  but  whenever  the 
cough  came  on,  even  if  the  fit  was  slight,  the  respiration  became 
hurried  and  irregular.     The  cough,  also,  produced  pain  in  the 
region  of  the  stomach,  which  the  patient  was  obliged  to  press  with 
his   hands,  during   the  paroxysms,  to   give   himself  ease.     Slight 
pressure  upon  the  epigastric  region  brought,  on  the  cough,  and  pro- 
duced considerable  pain:  a  deep  inspiration  had  the  same  effect. 
The  chest  was  sonorous  in  all  parts  ;  the  patient  could  lie  in  any 
position  without  producing  any  influence  upon  the  cough,  even 
since  the  fever  had  become  violent,  and  the  former  so  much  in- 
creased in  intensity.     Such  were  the  symptoms  observed  in  the 
chest.     On  examining  the  state  of  the  digestive  organs  and  their 
dependencies,  we  found  the  epigastrium  hot,  tender,  and  painful  on 
pressure;  the  tongue  vividly  red  at  its  point  and  edges,  its  upper 
surface  covered  with  a  whitish  pellicle;  the  throat  and  fauces  were 
hot.     Food  of  any  kind  when  taken,  even  before  the  commence- 
ment of  the  fever,  produced  pain  in  the  stomach  and  a  paroxysm 
of  coughing.     The  bowels  had  been  constipated  for  some  time; 
he  had  profuse  perspiration  occasionally,  which,  instead  of  procur- 
ing relief,  accelerated  the  progress  of  emaciation  ;  the  mental  con- 
stitution of  the  patient  became  much  depressed,  and  the  counte- 
nance hollow  and  anxious. 

The  aggregate  of  these  symptoms  resemble,  very  much,  an 
organic  affection  of  the  lungs  ;  but  the  absence  of  physical  signs  of 
disease  in  these  organs,  with  the  positive  indications  afforded  of 
the  inflamed  condition  of  the  stomach,  pointed  to  this  as  the  primi- 
tive and  chief  seat  of  disease. 

Two  relays  of  leeches,  of  fifteen  at  each  application,  were 
applied  over  the  region  of  the  stomach,  domestic  enemas  were 
employed,  and  the  patient  was  limited  to  a  strict  dietetic  regimen. 
On  the  twentieth  day  of  treatment  he  ate  with  impunity  of  a  mixed 
diet;  not  the  least  symptom  of  any  pectoral  affection  remained. 

Remarks. — On  examining  this  case  carefully,  we  shall  find  that 
here,  as  in  the  last  instance,  there  exist  a  class  of  symptoms  indi- 
cating pulmonary  irritation,  combined  with  a  second  class  referable 
to  the  condition  of  the  stomach.  For  four  months,  we  have  a  dry 

1  J.  B.  de  Lairoque,  De  quelques  Maladies  Abdominales,  qui  simulent 
Maladies  de  Poitrine,  2me.  Qhs.  p.  12. 


INFLUENCE  OP  ITS  MORBID  STATES  ON  THE  LUNGS.     131 

cough  in  existence,  which  is  invariably  produced  by  eating;  at  the 
same  time,  the  food  occasions  pain  and  uneasiness  in  the  stomach. 
Suddenly  the  symptoms  become  acute ;  we  have  fever,  vomiting, 
pain  in  the  stomach,  epigastric  tenderness,  a  red  tongue,  approach- 
ing to  an  aphthous  condition  ;  whilst,  accompanying  this  condition 
of  irritation  in  the  digestive  organs,  the  cough  becomes  more  active 
and  tearing.  Pectoral  remedies  in  the  first  instance,  before  the 
onset  of  fever,  do  not  allay  the  cough,  they  increase  it  doubtless  by 
adding  to  the  irritation  already  existing  in  the  stomach.  The 
absence  of  physical  signs  of  disease  in  the  lung  are  here,  again, 
worthy  of  notice.  The  patient  could  lie  in  any  position  without 
increasing  the  cough,  and  the  chest  was  every  where  resonant. 
The  treatment,  when  the  affection  has  become  acute,  is  applied  to 
the  relief  of  the  inflammatory  affection  of  the  stomach,  and  as  this 
subsides  we  observe  the  symptoms  of  pulmonary  irritation  become 
less,  and  at  length  altogether  disappear.  The  origin,  progress,  and 
termination,  of  disease  in  the  chest,  as  well  as  the  result  of  treat- 
ment prove  beyond  question  that  the  chest  affection  was  called  into 
existence  by  the  inflamed  condition  of  the  stomach,  upon  which  it 
was  strictly  dependent. 

The  nature  of  the  affection  of  the  chest  demands  our  attention  : 
mere  irritation  of  the  lungs,  under  the  form  of  cough,  without  ex- 
pectoration. No  symptom  of  any  inflammatory  affection,  as  bron- 
chitis, pneumonia,  or  pleurisy.  We  shall  observe,  however,  in 
pursuing  our  investigations,  that  these  forms  of  pulmonary  irrita- 
tion, if  continued,  soon  degenerate  into  one  of  the  forms  of  inflam- 
mation I  have  alluded  to,  and  are,  in  some  instances,  followed  by 
phthisis,  of  which  Andral,  De  Larroque,  and  myself,  have  reported 
examples. 

Those  forms  of  gastritis,  which  are  accompanied  by  cough, 
become  complicated  the  more  easily  with  pleurisy  or  pneumonia, 
as  the  chest  of  the  subjects  is  more  irritable,  and  the  paroxysms  of 
cough  more  violent  and  frequent.1 

CASE  3. — Long-continued  chronic  gastritis,  with  cough. — Subsequently 
expectoration  of  a  quantity  of  muco-purulent  matter,  to  the  extent  of 
three  half-pints  daily. — Cure 

A  gentleman,  aged  forty-five,  indulging  freely  in  the  pleasures  of 
the  table, -had  been  subject  to  indigestion  of  the  inflammatory  kind 
for  twenty-live  years,  during  the  whole  of  which  time  he  had 
almost  daily  vomited  some  portion  of  his  food;  in  fact,  this  was 
the  symptom1  for  which  he  first  consulted  me.  At  the  time  of  my 
first  attendance  upon  him  he  presented  the  following  state: — 
Sallow  countenance,  smooth  red  tongue,  nausea,  succeeding  to 

1  De  Larroque,  Op.  cit.  See,  also,  the  opinions  of  Dr.  Stokes  on  this  point 
Cyclopaedia  of  Practical  Medicine,  art.  Gastritis;  Lectures  in  the  Medical 
and  Surgical  Journal,  &c. 


132  PARKER    ON    THE    STOMACH. 

each  meal,  and  terminated  by  vomiting ;  tenderness  in  the  epigas- 
tric region,  which  was  hard  and  resisting.  The  pulse  exceeded  a 
hundred,  and  there  was  a  short,  dry  cough,  without  any  expectora- 
tion. The  patient,  during  the  last  few  months,  had  become  much 
emaciated.  The  respirations  were  generally  free,  but  occasionally 
hurried  and  irregular.  In  all  points  the  chest  was  perfectly  reso- 
nant, the  most  careful  and  repeated  examination  by  the  stethoscope 
detected  no  disease.  The  symptoms  continued  much  in  this  state 
for  many  weeks  ;  sometimes  the  derangements  connected  with  the 
stomach  were  relieved,  at  other  times  they  were  worse.  The  fits 
of  coughing  now  terminated  by  the  expectoration  of  a  little  slimy 
mucous  ;  this  went  on  increasing  till  upwards  of  a  pint  and  a  half 
of  muco-purulent  fluid  was  spat  up  in  the  course  of  a  day  and 
night.  With  this  there  was  occasional  vomiting;  but.  since  the 
establishment  of  the  free  expectoration,  the  symptoms  connected 
with  the  stomach  had  been  decidedly  ameliorated.  After  the  con- 
tinuance of  the  catarrh  for  many  weeks,  there  did  not  appear  to 
remain  any  stomach  affection.  Small  doses  of  the  dilute  nitric 
acid  were  administered,  and  a  combination  of  hyoscyamus  and 
ipecacuanha  given.'  Under  this  plan  the  patient  gradually  reco- 
vered from  the  affection  of  the  chest,  and  with  it  disappeared  all 
complaint  in  the  stomach,  from  which  this  gentleman  had  never 
been  free  a  day  for  twenty-five  years. 

Remarks. — In  this  case,  several  particulars  are  worthy  of  notice. 
All  the  symptoms,  with  which  this  patient  had  been  troubled, 
through  a  long  period,  were  evidently  dependent  on  a  chronic  state 
of  inflammation  of  the  mucous  coat  of  the  stomach.  The  symp- 
toms which  denoted  this  condition  of  the  stomach  were  unusually 
rebellious.  They  were  palliated,  and  relieved  sometimes  for  a 
week  together,  but  again  recurred  with  their  primitive  severity. 
At  this  period,  the  catarrh,  with  expectoration,  set  in :  when  the 
latter  was  fully  established,  the  disease  in  the  stomach  began  to 
subside,  and  ultimately  disappeared.  The  catarrhal  affection  ap- 
pears to  have  acted  as  a  revulsive  upon  the  disease  of  the  stomach, 
and  thus  to  have  cured  it.  Occasionally  affections  of  the  chest  and 
stomach  alternate  in  this  manner;  we  observe  one  subsiding  as 
the  other  is  aggravated.  Andral,  with  his  usual  correct  and  pene- 
trating observation,  has  observed  cases  of  this  character  in  con- 
sumptive patients,  on  which  he  remarks,  that  one  organ  acts,  by 
way  of  revulsion,  upon  the  other.1  In  many  instances,  however, 
the  increase  of  disease  in  the  stomach  is  attended  by  a  correspond- 
ing aggravation  of  it  in  the  lungs,  as  in  the  two  first  cases  detailed. 

CASE  4. — Sub -acute  inflammation  of  the  stomach,  producing  the  symptoms 
of  acute  catarrh. — Cure  of  the  pectoral,  by  the  removal  of  the  stomach 
disease. 

J.  E.,  thirty-two  years  of  age,  ill,  for  two  years,  with  pain  in  the 
epigastrium,  sickness,  and  occasional  vomiting. 

1  Clinique  Medicale,  p.  529. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.    133 

June  8,  1834. — Constant  pain  in  the  stomach,  aggravated  to  a 
great  degree  by  taking  food,  which  is  commonly  rejected  by  vomit- 
ing^ great  tenderness  in  the  epigastrium,  the  slightest  pressure 
occasions  most  violent  pain,  which  is  confined  to  a  small  surface ; 
the  epigastrium  hard  and  tense,  feeling  as  though  some  resisting 
body  lay  under  the  muscles.  There  is  no  uneasiness  whatever  in 
any  other  part  of  the  abdomen.  The  tongue  is  coated  with  a  yel- 
lowish brown  fur,  red  at  its  point  and  edges,  the  papillae  enlarged 
and  florid.  Countenance  anxious  and  pale ;  extremities  cold  ; 
pulse  small  and  frequent ;  great  irregularity  of  breathing,  with 
constant  cough  and  bloody  expectoration  ;  the  stools  occasionally 
streaked  with  blood.  The  patient  was  limited  to  a  strict  farinace- 
ous diet;  bottles  of  hot  water  applied  to  the  feet;  twelve  leeches 
to  the  epigastrium.  The  leeches  were  repeated  on  the  9th,  10th, 
1 1th,  and  12th,  to  the  same  part,  in  less  number,  proportionate  to 
the  degree  of  complaint;  on  the  12th  they  were  succeeded  by  a 
blister.  On  the  20th.  the  food,  which  then  consisted  of  thin  ani- 
mal broth,  occasioned  no  pain  ;  no  tenderness  in  the  epigastrium 
on  pressure;  the  difficulty  of  breathing  had  subsided,  arid  there 
was  neither  cough  nor  expectoration.  The  patient,  during  the 
whole  course  of  his  disease,  took  no  other  medicine  than  a  few 
grains  of  the  ponderous  carbonate  of  magnesia  with  morphia,  when 
the  acidity  accompanying  the  vomiting  was  very  intense. 

Remarks. — This  is  another  example  of  inflammatory  disease  in 
the  mucous  membrane  of  the  lungs,  succeeding  to  a  similar  condi- 
tion of  the  mucous  membrane  of  the  stomach.  In  this  case,  we 
observe  the  stomach  affection  to  have  been  in  existence  two  years 
before  the  respiratory  organs  became  affected.  Complaint  in  both 
organs  disappears,  from  remedies  directed  solely  to  the  removal  of 
the  gastric  disease. 

CASE  5.— Inflammation  of  the  stomach,  simulating  inflammation  of  the 
mucous  membrane  of  the  lungs. — Healthy  state  of  the  lungs  ascer- 
tained after  death. — Disease  confined  to  the  mucous  membrane  of  the 
stomach.1 

A  surgeon,  aged  twenty-four,  who  had  occasionally  been  subject 
to  severe  colds  and  spitting  of  blood,  became  indisposed  after  break- 
fasting for  a  fortnight  on  bread  soaked  in  wine.  On  the  eighth 
day  of  his  illness  he  presented  the  following  symptoms: — General 
fever,  loss  of  appetite,  internal  heat  in  the  stomach,  thirst,  pulse 
full,  hard,  and  irregular;  he  complained  of  pain  in  the  chest  and 
a  sense  of  tightness  across  the  epigastric  region.  He  was  restless, 
and  continually  drawing  deep  sighs.  At  the  commencement  of 
the  complaint,  he  had  spat  a  little  blood ;  but,  subsequently,  he  had 
been  unable  to  cough  fully,  notwithstanding  the  irritation  which 
continually  prompted  him  to  do  so,  on  account  of  the  excruciating 
pain  which  the  force  of  the  cough  occasioned. 

On  the  following  day,  the  violence  of  the  cough  allowed  him  no 

1  Broussais,  Histoire  des  Phlegmasies  Chroniques,  t.  ii.,  p.  448. 


134  PARKER  ON  THE  STOMACH. 

rest.  He  then  informed  his  medical  attendant  that,  on  the  first 
days  of  complaint,  the  food  taken  had  been  rejected  by  vomiting. 
Leeches  were  now  applied  to  the  epigastrium  ;  they  had  the  effect 
of  relieving  the  pain  in  the  chest  and  stomach,  and  almost  entirely 
removing  the  cough.  Some  aromatic  antispasmodic  remedies  were 
administered;  they  were  rejected  by  vomiting.  Some  acidulated 
gummy  preparations  were  retained.  During"  the  remaining  days 
of  his  existence,  the  chief  circumstances  remarked,  were  vomiting 
of  the  stimulating  and  cordial  remedies,  or  an  increase  in  the  rest- 
lessness, anxiety,  and  distress  of  the  patient  when  they  were  not 
vomited.  Whilst  these  were  rejected,  the  mucilaginous  and  acidu- 
lated medicines  remained  upon  the  stomach  and  appeared  to  afford 
relief.  He  died  on  the  eighteenth  day  of  disease. 

Post-mortem  examination.-—  The  lungs  and  viscera  of  the 
chest,  perfectly  healthy.  The  stomach  contracted  to  the  size  of 
the  small  intestines ;  its  consistence  hard ;  its  mucous  membrane 
thickened,  of  a  deep  dark  red  colour,  approaching  in  many  places 
to  black.  All  the  intestines  were  contracted,  their  mucous  sur- 
faces dry  and  of  a  bright  red  colour.  The  capillary  vessels  of  the 
mesentery,  also,  much  injected. 

Remarks. — This  is  the  first  case  detailed  in  which  we  have  an 
opportunity  of  examining  the  state  of  the  lungs  and  stomach  after 
death,  in  diseases  of  the  character  of  which  we  are  speaking. 
The  dissection  shows  us  the  lung  and  its  membranes  perfectly 
healthy,  whilst  the  stomach  and  intestines  bear  the  evidences  of 
the  most  acute  form  of  inflammation.  Many  of  the  symptoms  of 
gastritis,  in  this  case,  were  obscure,  and  masked  by  the  pulmonary 
affection,  which  consisted  in  constant  cough  with  occasional  expec- 
toration of  blood.  The  bloody  sputa  may  be  explained  by  the  state 
of  congestion  into  which  the  lungs  was  thrown,  consequent  upon 
the  violent  irritation  which  produced  and  accompanied  the  cough  : 
thus,  blood  might  be  exhaled  upon  the  mucous  membrane  of  the 
bronchiae  during  the  violence  of  a  paroxysm.  The  effects  of  reme- 
dies should  here  be  carefully  noted ;  the  leeches  to  the  epigastrium 
mitigated  the  cou^h  most  materially.  The  stimulant  remedies 
(juleps  aromatises  et  antispasmodiques)  added  to  the  pulmonary 
irritation,  as  well  as  to  the  generel  distress  of  the  patient;  mucila- 
ginous and  acidulated  drinks  were  taken  with  pleasure,  and  pro- 
cured relief.  When  pulmonary  irritation  arises  in  the  stomach, 
we  may  easily  conceive  of  the  increase  of  complaint  in  the  lungs, 
occasioned  by  the  impression  of  stimulating  medicines  upon  a 
membrane  rendered,  by  inflammation,  "as  sensible  as  an  erysipe- 
latous  skin. 

CASE  6.1 — Catarrhal  and  pneumonic  symptoms  during  life,  dependent  upon 
acute  inflammation  of  the  stomach. — Healthy  condition  of  the  lungs. 

A  man,  previously  healthy,  entered  the  hospital  Udine,  suffering 
1  Broussais7  Histoire  des  Phlegmasies  Chroniques,  tome  ii.,  p.  459. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.          135 

from  rheumatism.  After  remaining  there  for  some  time,  he  was 
seized  with  cough  and  general  fever.  He  at  that  time  presented 
the  following  symptoms :— Frequent,  sharp  pulse,  hot  skin,  patched 
cheeks,  loss  of  appetite,  dry  coated  tongue,  with  distaste  for  all  kinds 
of  drinks.  He  had,  at  the  same  time,  constant  fits  of  coughing, 
with  copious  expectoration  and  hurried  breathing;  no  fixed  pain 
existed  in  any  point  of  the  chest,  but  the  patient  indicated  the  right 
side,  under  the  sternal  ribs,  as  the  point  of  deep-seated  pain.  He 
was  supposed,  by  his  medical  attendants,  to  be  suffering  from  acute 
bronchitis,  and  treated,  accordingly,  with  leeches  and  blisters  to  the 
chest,  to  which  were  added  some  expectorant  remedies.  The  pa- 
tient died  on  the  tenth  day  of  the  disease. 

Post-mortem  examination. — The  lungs  were  free  from  disease, 
merely  presenting  a  slight  degree  of  congestion.  The  stomach  was 
contracted,  as  in  the  Ias4  case,  to  the  size  of  the  small  intestine ; 
its  mucous  coat  was  thickened,  and  of  a  deep-red  colour,  deepening 
to  violet  towards  the  pyloric  portion  of  the  organ.  The  small  in- 
testines were  contracted  also,  arid  red  ;  the  large  intestines  presented 
similar  appearances. 

Remarks. — The  detail  of  symptoms  during  life  are  so  loosely 
given  by  Broussais,  in  his  account  of  this  case,  that  without  the 
account  of  the  impression  upon  his  own  mind,  that  the  patient  was 
labouring  under  a  bronchitis,  approaching  to  a  condition  of  general 
inflammation  of  the  lung,  we  should  be  at  a  loss  to  determine  on 
the  nature  of  the  disease.  The  dissection,  however,  clears  all 
doubtful  points.  We  find,  on  examination,  the  lungs  healthy,  ex- 
cepting a  slight  degree  of  congestion;  whilst  the  stomach  and 
intestines  exhibit  marks  of  most  intense  inflammatory  action. 
Here,  as  in  the  last  case,  the  nature  of  the  disease  was  miscon- 
ceived; both  were  supposed  to  exist  in  the  chest,  but  dissection 
shows  that  they  were  seated  in  the  stomach  and  intestines. 

Case  7.1 — Catarrhal   symptoms,  dependent  on   acute   inflammation  of  the 

stomach. 

.A  stout  man,  aged  twenty-seven,  entered  the  hospital  Udine  with 
cough  and  symptoms  of  indigestion.  On  the  sixth  day  of  dis- 
ease he  presented  the  following  symptoms:  Considerable  dyspnoea, 
patched  and  flushed  cheeks,  great  heat  of  skin,  a  full,  frequent,  and 
hard  pulse,  constant  fits  of  coughing,  which  followed  each  inspira- 
tion; the  cough  caused  severe  pain,  and  was  accompanied  by  a 
frothy  expectoration,  tinged  with  blood.  The  patient  complained 
of  no  fixed  uneasiness,  although  the  whole  surface  of  the  fore  part 
of  the  chest  was  painful.  The  anxiety  and  distress  were  extreme; 
there  existed  a  disgust  for  all  kinds  of  fluids,  whilst  the  mouth  was 
very  foul.  The  patient  was  bled  in  the  arm  twice,  and  two  blisters 
were  applied  to  the  chest.  On  the  eighth  day  of  disease  the 
anxiety,  agitation,  and  the  convulsive  cough,  continued;  the  little 

Broussais,  Des  Phlegmasies  Chroniques,  tome  ii.,  p.  466,  Case  3. 


136  PARKER  ON  THE  STOMACH. 

expectoration  which  existed  at  the  commencement  of  disease  had 
now  ceased,  and  the  cough  was  perfectly  dry.  To  these  symptoms 
were  now  added  diarrhoea  and  tenesmus. 

The  patient  sunk  into  a  state  of  stupor  on  the  sixteenth  day  of 
disease,  the  looseness  of  the  bowels,  and  the  general  distress  and 
agitation,  continuing. 

Post-mortem  examination. — The  lungs  were  adherent,  but  the 
adhesions  were  of  old  standing.  Their  substance  was  healthy,  but 
congested.  The  stomach,  in  all  parts,  inflamed,  of  a  deep  violet 
colour,  approaching  to  blackness  towards  the  cardiac  portion. 
Spots,  resembling  ecchyrnoses  in  the  greater  curvature,  with  thin- 
ning of  its  coats  in  this  situation.  Redness,  at  intervals,  of  the 
mucous  membrane  of  the  intestines. 

Remarks. — In  these  three  cases,  which  are  detailed  at  great 
length  by  Broussais,  he  confesses  himself  ignorant  as  to  the  true 
nature  of  the  disease,  till  the  autopsy  revealed  it  to  him.  He  had  a 
suspicion  of  the  nature  of  the  last  case,  and,  acting  upon  this, 
abstained  from  the  use  of  stimulating  expectorant  remedies,  which 
had  aggravated  the  condition  of  the  two  first  patients.  These  cases, 
in  a  practical  point  of  view,  are  highly  important:  we  observe  in 
them  the  general  characters  of  gastritis  wanting,  the  more  prominent 
symptoms  being  observed  in  derangements  of  the  organs  of  respira- 
tion. In  the  first  case  only,  have  we  vomiting  present ;  in  the  last, 
some  diarrhoea.  The  pains  were  chiefly  felt  in  the  chest :  in  the 
second  case,  they  existed  in  the  right  hypochondriac  region.  I 
refer  the  reader  to  the  first  part  of  this  work,  for  details  upon  the 
uncertainty  of  the  symptoms  of  gastritis  ;  remarking  here,  that,  the 
pains  which  are  symptomatic  of  this  disease,  are  very  commonly 
felt  on  some  part  of  the  surface  of  the  chest.  Broussais  lays  great 
stress  upon  the  extreme  anxiety,  and  restlessness  of  these  patients,  as 
features  of  gastric,  rather  than  of  pulmonary  disease.  No  account 
is  given  of  the  condition  of  the  bronchial  mucous  membrane  in  these 
cases  ;  but  we  must  not  omit  his  remarks  upon  this  omission  : — "  I 
am  now  convinced,"  says  he,  "  that  redness  existed  in  the  bronchial 
mucous  membrane  of  these  three  patients,  but  it  was  not  verified. 
The  cough,  although  sympathetic,  could  not  fail  to  produce  conges- 
tion of  these  membranes,  when  frequently  repeated.  In  this  manner 
phthisis  is  produced  by  diseases  of  the  stomach."1  In  this  way, 
also,  the  bloody  expectoration  may  be  explained,  as  we  shall  see 
subsequently,  in  the  details  of  some  cases  of  incipient  phthisis. 

Having  noticed  the  influence  of  inflammatory  diseases  of  the 
stomach  upon  the  lining  membrane  of  the  lungs,  we  proceed  to 
notice  some  facts  connected  with  their  influence  in  the  production 
of  diseases  resembling  pleurisy. 

1  Op.  cit.,  t.  ii.,  p.  469.     Note. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.     137 


CASE  8. — Inflammation  of  the  stomach  accompanied  by  cough,  assuming 
subsequently  the  rational  symptoms  of  pleurisy.1 

A  young  man,  aged  25,  contracted  a  venereal  affection,  for  which 
he  was  ordered  to  take  the  solution  of  the  oxymuriate  of  mercury, 
commonly  known  by  the  name  of  "  Yari  Swieten's  Liquor."  Per- 
ceiving no  amelioration  in  his  symptoms  after  a  fortnight's  use  of 
the  medicine,  he  increased  the  dose  till  he  had  taken,  in  the  course 
of  one  day,  three  large  spoonfuls  of  the  solution.  This  produced 
violent  pains  in  the  stomach,  incessant  vomiting,  giddiness,  and 
general  uneasiness  ;  he  abandoned  the  use  of  his  remedy,  and  drank 
freely  of  diluents,  the  vomiting  ceased,  but  the  pain  in  the  stomach 
continued.  On  the  next  day,  an  acute  pain  under  the  left  breast 
came  on,  which  appeared  to  be  connected  with  that  already  existing 
in  the  stomach.  This  pain  was  accompanied  by  frequent  and  dry- 
cough,  a  red  tongue,  and  distressing  thirst.  The  pulse  frequent 
and  hard  ;  the  surface  of  the  body  cold.  The  pain  in  the  side  was 
increased  whenever  the  gastric  symptoms  were  aggravated  ;  pres- 
sure on  the  epigastrium,  by  adding  to  the  uneasiness  in  this  region, 
likewise  added  to  that  in  the  side. 

Leeches  were  applied  over  the  epigastrium,  and  the  patient  was 
placed  in  a  warm  bath.  On  the  next  day  all  the  symptoms  had 
disappeared. 

It  is  evident  that,  in  this  case,  the  patient  was  suffering  from  acute 
gastritis,  the  result  of  an  over-dose  of  the  oxymuriate  of  mercury  ; 
the  pain  in  the  side,  resembling  pleurisy,  being  purely  sympathetic. 
In  the  next  case,  we  shall  observe  this  kind  of  pain  occurring  after 
long-continued  gastric  irritation,  and  accompanied  by  irregular 
action  of  the  heart,  so  that  the  disease  resembled,  in  some  measure, 
pericarditis,  or  a  complication  of  pleurisy  with  some  affection  of  the 
heart. 

CASE  9. — Long-continued  gastric  irritation,  becoming  acute,  accompanied  by 
pains  resembling  pleurisy,  and  by  irregularity  in  the  action  of  the  heart. 

A  gentleman  had,  for  some  time,  suffered  from  nausea,  loss  of 
appetite,  flatulence,  and  almost  daily  vomiting  of  food.  He  had,  at 
the  same  time,  cough,  difficulty  of  breathing,  and  a  sense  of  oppres- 
sion seated  over  the  centre  of  the  sternum.  There  was  considerable 
tenderness  in  the  epigastrium,  increased  to  acute  pain  by  slight 
pressure.  The  stools  were  very  dark.  The  action  of  the  heart  was 
also  laboured  and  irregular,  the  pulse  intermitting  every  five  or  six 
beats.  Suddenly,  these  symptoms,  which  had  been  varying  in  their 
degree  of  intensity  for  three  or  four  months,  became  acute  ;  the 
oppression  over  the  sternum  increased,  and  was  accompanied  by 
sudden  and  acute  pain  in  the  right  side,  over  the  heart,  the  action 

1  De  Larroque,  Op.  cit.,  c.  i.,  case  5. 


138  PARKER  ON  THE  STOMACH. 

of  which  organ  was  much  more  embarrassed.  With  this,  the  ten- 
derness and  pain  in  the  region  of  the  stomach  also  increased  in 
violence.  The  most  careful  examination  of  the  lungs  and  heart,  by 
auscultation,  detected  no  disease  :  all  the  organs  of  the  chest  appeared 
healthy.  The  long  continued  symptoms  of  inflammatory  indiges- 
tion, led  me  to  conclude  that  the  pain  in  the  side  and  chest,  with  the 
condition  in  the  heart's  action,  were  dependent  upon  acute  inflam- 
mation of  the  mucous  coat  of  the  stomach,  suddenly  supervening 
upon  a  chronic  state  of  disease.  The  epigastrium  was  freely 
leeched,  the  hydrocyanic  acid  was  given,  at  the  same  time,  inter- 
nally, with  a  combination  of  the  carbonate  of  magnesia  and  Dover's 
powder.  The  oppression,  the  acute  pain,  the  cough,  and  irregular 
and  laboured  action  of  the  heart,  ceased  as  the  epigastric  tenderness 
and  pain  were  removed.  After  all  the  acute  symptoms  had  subsided 
there  remained  occasionally  a  little  irregularity  in  the  heart's  action ; 
this  ceased  from  the  administration  of  a  few  minims  of  the  tincture 
of  ammoniated  iron,  twice  or  three  times  in  the  day. 

Remarks. — We  observe,  in  this  case,  symptoms  of  chronic  gas- 
tritis existing  for  several  months,  accompanied  by  cough,  and  irre- 
gular action  of  the  heart.  Suddenly,  constricting  pain  in  the  chest 
comes  on,1  with  oppression  over  the  centre  of  the  sternum,  and  with 
this,  acute  pain  in  the  side,  laboured  action  of  the  heart,  and  inter- 
mittent pulse.  The  stethoscope  indicates  no  disease,  either  in  the 
heart  or  lungs.  The  symptoms  all  disappear  from  a  treatment 
framed  for  the  removal  of  the  stomach  disease. 

It  is  certain  that  Andral  supposed  in  the  following  passage,  that 
inflammation  of  the  lungs  might  succeed  to,  and  be  dependent  upon, 
inflammatory  disease  of  the  stomach.  "  In  the  acute  state,  in  the 
diseases  called  continued  fevers,  the  inflammation,  congestion,  or 
irritation,  which  exists  in  the  gastro-intestinal  mucous  membrane, 
usually  extends  to  the  air-passages,  whether,  limiting  itself  to  the 
great  bronchial  ramifications,  it  constitutes  a  simple  catarrh,  or, 
attacking  the  pulmonary  vesicles,  it  is  changed  into  a  pneumo- 
nia. In  the  chronic  state  we  may,  again,  observe  the  same  simul- 
taneous existence  of  disease."2  Stoll  has  recognised  the  same 
morbid  conditions  of  both  organs  under  the  title  of  "  bilious  pneu- 
monia." 

CASE  10. — Inflammation  of  the  lungs  complicated  with  and  apparently  suc- 
ceeding to,  that  of  the  stomach — Cure  of  the  pulmonary  by  the  chief 
attention  to  the  stomach  disease. 

J.  G.,  an  athletic  man,  states  that  he  had  been  ill  a  fortnight  at 

1  This  constricting  pain  in  the  chest,  with  oppression  over  the  centre  of 
the  sternum,  is  one  of  the  most  frequent  incipient  symptoms  of  gastritis,  as 
well  as  of  some  forms  of  pneumonia.  When  the  physical  symptoms  of  dis- 
ease of  the  lung  are  absent,  these  pains  are  generally  symptomatic  ot  some 
inflammatory  affection  of  the  stomach. 

•  Op.  cit.,  by  Spillan,  p.  513. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.     139 

the  time  of  his  first  application  for  medical  assistance.  He  then 
complained  of  acute  pain  in  the  epigastrium,  with  a  sense  of  con- 
striction ;  the  pain  was  aggravated  to  a  great  degree  by  slight 
pressure.  Food,  and  drink  of  all  kinds,  added  to  his  distress,  and 
were  constantly  rejected  by  vomiting.  There  was  no  pain  or 
uneasiness  in  any  other  part  of  the  abdomen.  The  countenance 
was  anxious,  the  tongue  red  at  its  point  and  edges,  and  the  pulse 
small,  frequent,  and  fluttering.  There  was  considerable  difficulty 
of  breathing  on  slight  exertion. 

On  carefully  examining  the  chest  by  auscultation,  there  was  a 
strong  "  rale  crepitant"  occupying  the  whole  of  the  superior  lobe 
of  the  left  lung,  most  distinctly  marked,  both  in  the  infra-clavicular, 
the  axillary,  and  scapular  regions.  I  disregarded  the  pain  in  the 
epigastrium  and  the  constant  sickness,  and  ordered  the  patient  to  be 
freely  bled  from  the  arm.  The  blood  presented  the  usual  charac- 
teristics :  the  clot  was  firmly  contracted,  and  covered  with  a  layer 
of  lymph  half  an  inch  thick.  On  the  succeeding  day  the  patient's 
state  was  not  at  all  amended;  the  "  rale"  continued  as  intense,  and 
the  symptoms  of  gastric  derangement  were,  if  possible  more  urgent. 
Leeches  were  now  applied  to  the  epigastrium,  and  the  patient  took 
the  smallest  quantities  of  cold  gruel.  On  the  following  day  he  was 
much  relieved;  the  difficulty  of  breathing  and  "rale  crepitarit," 
were  much  less,  and  had  abated  in  direct  proportion  to  the  mitiga- 
tion of  the  stomach  disease.  The  local  depletion  was  continued 
for  a  few  days,  and  the  patient  continued  the  plan  of  abstinence, 
except  from  thin,  cold  gruel.  On  the  tenth  day  of  disease  there 
was  no  sickness  or  epigastric  tenderness  ;  he  could  take  food  with- 
out pain  or  distension :  no  difficulty  of  breathing,  and  no  trace  of 
any  morbid  "rale"  in  the  lung.  I  believe  I  am  correct  in  stating 
that  this  patient  took  no  medicines  during  the  continuance  of  his 
disease. 

Remarks. — Whether  the  gastritis  or  the  pneumonia  were,  in 
this  instance,  the  primary  affection,  I  cannot  pretend  to  say,  and  it 
is  of  little  moment ;  it  is  plain  there  was  inflammation  of  the  two 
organs  in  an  acute  form.  It  is  to  be  remarked,  that  the  bleeding  on 
the  first  day  of  the  patient's  application  did  not,  apparently,  benefit 
the  inflammation  of  the  lungyatid  certainly  did  not  at  all  relieve 
the  symptoms  of  gastritis.  The  first  application  of  leeches  to  the 
epigastrium  benefited  both ;  and  this  was  the  sole  remedy  that  was 
afterwards  employed.  I  should  be  inclined  to  believe,  from  the 
effects  of  the  remedies  employed,  that  the  pneumonia  was  subse- 
quent to,  and  dependent  upon,  the  gastritis  ;  though,  if  the  disease 
had  been  permitted  to  go  on  unchecked,  it  would  riot  have  been 
relieved,  as  it  evidently  was,  by  leeching  the  epigastrium  alone. 
However  this  may  be,  the  case  shows  that,  in  certain  states,  there 
exist  sympathies  between  the  lungs  and  the  stomach,  which  render 
disease  in  one  a  cause  of  disease  in  the  other.  I  think,  on  careful 
examination  of  the  results  of  the  treatment,  there  can  be  little 
doubt  of  the  pneumonia  having  succeeded  to  the  gastritis,  which 


140  PARKER  ON  THE  STOMACH. 

became  its  exciting  cause.  The  similarity  of  the  next  case  renders 
this  almost  a  matter  of  certainty. 

CASE  11. — Pneumonia,  with  symptoms  of  gastritis. 

J.  H .,  an  athletic  labourer,  about  forty  years  of  age, 

became  unwell  on  the  29th  of  December,  with  pain  in  the  stomach 
and  vomiting  of  food.  At  the  time  of  his  application  he  had 
constant  sickness ;  the  stomach  rejected  every  thing  that  was 
taken;  acute  pain  in  the  epigastrium,  increased  to  agony  by  pres- 
sure. The  breathing  was  hurried,  accompanied  by  constant  cough, 
and  expectoration  of  frothy,  brown-coloured  mucus ;  the  pulse 
small,  frequent,  and  unsteady.  On  examining  the  chest  by  per- 
cussion and  auscultation,  it  was  observed  that  there  existed  a 
slight  dulness  over  the  middle  lobe  of  the  right  lung.  The  respira- 
tion here  was  only  distinct  in  places,  and  where  it  was  evident, 
accompanied  by  a  strong  "rale  crepitant."  In  the  whole  of  the 
superior  lobe  of  the  same  lung  the  "rale"  was  strongly  marked. 
On  the  30th  his  state  was  worse.  The  tenderness  in  the  epigas- 
trium was  very  great,  although  the  sickness  had,  in  some  measure, 
abated.  The  right  side  of  the  chest  duller  on  percussion  than 
yesterday;  the  "rale  crepitant"  was  strongly  marked  in  places,  but 
in  many  points  the  respiration  was  absent.  Leeches  were  applied 
over  the  chest  yesterday,  and  to-day  the  patient  was  bled  from 
the  arm. 

December  31st. — The  respiration  more  distinct  in  the  upper 
and  lower  portion  of  the  lung.  The  "rale"  accompanying  it  in 
these  points  approaching  more  the  character  of  the  "rale  mu- 
queux."  In  the  centre  of  the  lung  there  is  still  absence  of  respira- 
tion in  points,  with  a  "rale  crepitant"  where  the  respiration  is  per- 
ceptible. Still  excessive  tenderness  in  the  epigastrium,  with  occa- 
sional vomiting.  Twelve  leeches  to  the  region. 

January  1st. — The  cough  and  difficulty  of  breathing  much 
relieved.  Pulse  steadier  and  fuller,  at  seventy.  The  patient  states 
that  the  relief  afforded  by  the  last  leeches  was  greater  than  all  the 
previous  treatment. 

On  the  4th  the  epigastric  tenderness  and  vomiting  had  disap- 
peared; there  was  no  hurried  breathing,  the  pulse  was  steady  and 
soft,  there  was  little  cough,  the  respiration  was  distinct  in  the  supe- 
rior lobe  of  the  lung,  absent  in  places  in  the  middle  and  inferior, 
accompanied,  where  present,  with  a  strong  "rale  muqueux."  In 
certain  places  the  respiration  was  distinct  and  natural  without  this 
complication. 

Remarks. — This  case  affords  another  example  of  the  compli- 
cation of  gastritis  and  pneumonia  similar  to  the  last,  although  the 
diseases,  in  this  instance,  appear  in  both  to  have  been  of  a  more 
acute  character.  We  find  the  symptoms  of  pneumonia  and  gas- 
tritis both  strongly  marked,  in  this  patient's  case,  on  the  first  appli- 
cation for  relief,  on  December  29th.  On  that  day,  and  on  the 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.          141 

30th,  local  depletion  from  the  surface  of  the  chest  and  general 
bleeding  were  resorted  to,  certainly  with  some  effect  upon  the 
inflammation  of  the  lung,  but  without  much  influence  upon  the 
cough  and  hurried  breathing.  On  the  31st  the  epigastrium  was 
covered  with  leeches,  and  at  this  period,  although  the  disease  was 
mitigated,  which  is  evident  from  the  physical  signs  afforded  by  the 
stethoscope,  the  sense  of  oppression  and  constriction  which  the 
patient  experienced,  with  the  hurried  breathing  and  cough,  did  not 
abate  till  the  application  of  leeches  to  the  stomach.  The  patient 
stated  that  to  himself  he  appeared  no  better  till  the  application  of 
leeches  to  this  part,  after  which  he  expressed  himself  greatly  bene- 
fited. I  do  not  pretend  to  offer  any  opinion  on  the  primary  seat  of 
disease  in  this  case ;  whether  one  organ  became  diseased  consecu- 
tively, and  in  consequence  of  morbid  action  in  the  other,  or 
whether  the  affections  were  merely  coincident.  This  is  difficult  to 
decide  ;  but  the  effects  of  the  treatment  prove  that  the  most  mark- 
ed benefit  resulted  to  the  disease  in  the  lung  from  the  remedies 
applied  to  the  stomach,  whilst  the  reverse  does  not  appear  to  have 
been  the  case. 

CASE  12. — Pleuro-pneumonia  co-existing  with  acute  inflammation  of  the 
intestines. — Injurious  effects  of  the  tartar-emetic.1 

A  young  man,  aged  twenty,  of  delicate  constitution,  was  admit- 
ted into  the  Hotel  Dieu  on  November  29th,  suffering  from  pain 
on  the  left  side  of  the  chest,  cough,  difficulty  of  breathing,  fever, 
and  bloody  expectoration.  On  the  30th  he  was  bled  in  the  arm. 
On  December  2d  the  dyspnoaa,  the  fever,  and  the  pain  in  the  side 
continued,  as  well  as  the  bloody  expectoration.  The  pulsations 
were  one  hundred ;  the  respirations  thirty-six  in  a  minute.  The 
signs  furnished  by  auscultation  and  percussion  were  almost  insig- 
nificant. The  chest  was  a  little  duller  on  the  left  side  than  on  the 
right.  The  ear  detected  neither  crepitation,  "souffle  bronchique," 
or  bronchophony.  Twenty  leeches  were  applied  to  the  painful 
point  on  the  side.  On  the  3d  no  amendment:  the  pulse  and 
respiration  were  as  frequent  as  on  the  2d ;  the  expectoration  was 
not  now  bloody.  In  the  axilla  of  the  left  side  a  slight  "rale  crepi- 
tant"  was  perceptible.  The  patient  was  again  bled  in  the  arm. 

On  the  succeeding  days  of  disease  the  difficulty  of  breathing 
became  still  greater,  and  the  pulse  kept  up  in  frequency.  The 
stethoscope  furnished  nothing  more  decisive  than  on  the  previous 
days  of  examination.  The  tartar-emetic  was  now  ordered  to  be 
given  in  large  doses,  notwithstanding  pain  which  existed  in  the 
abdomen^  and  a  relaxed  state  of  the  bowels.  The  difficulty  of 
breathing  continued  to  increase,  and  the  patient  died  on  the  9th. 

Post-mortem  examination. — The  superior  lobe  of  the  left  lung- 
was  hepatised  throughout,  as  well  as  a  portion  of  the  inferior  lobe. 

*La  Lancette  Fran9aise,  p.  10,  "Clinique  de  M.  Chomel,  Hotel  Dieu." 


142  PARKER  ON  THE  STOMACH. 

The  tissue  of  the  lung  was  hard  and  resisting,  and  did  not  present 
the  least  signs  of  softening.  The  pleura  contained  five  or  six 
ounces  of  sero-purulent  fluid,  and  its  surface  was  covered  with  a 
coating  of  lymph,  recently  effused.  A  few  tubercles  were  found 
in  the  apices  of  each  lung.  The  intestinal  mucous  membrane 
presented  traces  of  acute  inflammation. 

Remarks. — I  have  shown,  in  the  two  former  cases,  that  where 
pneumonic  symptoms  co-exist  with  inflammatory  affections  of  the 
stomach  and  bowels,  the  effects  of  general  bleeding,  as  well  as 
local  bleeding  from  the  surface  of  the  chest,  are  not  attended  with 
the  usual  well-marked  beneficial  results.  In  these  cases  no  evi- 
dent impression  was  made  upon  the  difficulty  of  breathing,  till  the 
epigastrium  was  leeched.  In  this  case  of  Chomel's  the  same  effects 
are  observed ;  the  fatal  issue  of  the  disease  was.  doubtless,  hasten- 
ed by  the  exhibition  of  the  tartar-emetic.  This  remedy  is  contra- 
indicated  in  all  cases  where  any  gastric  or  gastro-intestinal  irrita- 
tion co-exists  with  inflammation  of  the  lungs.  "It  ought  also," 
says  the  editor  of  this  case,  "to  be  proscribed  in  pneumonia  where 
there  is  reason  to  suspect  the  existence  of  tubercles ;  since,  in  a 
great  majority  of  instances  of  this  nature,  a  complication  of 
disease,  in  some  form,  is  generally  found  in  the  digestive  mucous 
surfaces. 

CASE  13. — A  gentleman,  aged  forty,  first  became  indisposed, 
some  years  before  the  present  date  (September  20th,  1835),  with 
the  following  symptoms: — Pain  and  distension  after  eating,  with 
nausea,  and  daily  vomiting  of  food.  These  symptoms  had  con- 
tinued, in  a  greater  or  less  degree,  for  some  months,  when  dry 
cough  came  on.  On  questioning  this  patient  closely  on  the  his- 
tory of  his  disease,  he  informed  me  that  he  had  been  perfectly 
healthy  till,  about  two  or  three  years  ago,  his  stomach  began  to 
swell  after  he  had  eaten  his  food,  which  was  generally  vomited. 
After  the  cough  had  continued  for  some  time,  it  was  followed  by 
expectoration  of  frothy  mucus.  I  had  attended  this  gentleman  at 
intervals  for  a  long  period;  he  had  found  most  relief  from  a  com- 
bination of  the  ponderous  carbonate  of  magnesia  with  Dover's 
powder,  and  the  occasional  application  of  a  small  number  of  leeches 
to  the  epigastrium.  On  the  last  attendance,  which  terminated  in 
his  death,  he  presented  the  following  state: — Earthy  and  sallow 
complexion  ;  tongue  vividly  red,  no  coating,  except  a  little  towards 
the  base;  constant  vomiting  of  every  thing  taken,  whether  solid 
or  fluid,  in  an  intensely  acid  state;  the  breathing  was  laboured  and 
difficult,  accompanied  by  constant  cough  and  hoarseness  ;  the  epi- 
gastrium was  painful,  constricted,  and  exceedingly  sensible  to 
pressure.  Six  leeches  were  ordered  to  the  epigastrium,  and  a 
twelfth  of  a  grain  of  morphia  administered  every  four  hours,  with 
ten  of  the  carbonate  of  soda. 

22d.  Infinitely  better.  Can  lie  down  in  bed,  which  he  has 
not  done  for  a  week;  less  cough;  less  difficulty  of  breathing; 
sickness  gone.  Slight  epigastric  tenderness  still  remaining,  with 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.     143 

considerable  fulness  after  food.  Repeat  the  leeches.  To  take  a 
combination  of  the  ponderous  carbonate  of  magnesia  and  the  com- 
pound powder  of  ipecacuanha. 

On  the  28th,  the  symptoms  became  much  worse.  Constant 
cough,  with  occasional  sickness,  an  intensely  red  tongue,  with 
feeble,  fluttering,  unsteady  pulse.  During  the  remaining  fourteen 
days  of  life,  the  stomach  did  not  retain  any  solid  food, "and  fluids 
were  mostly  rejected.  For  the  last  four  days,  the  pain,  sickness, 
and  oppression,  were  so  great  on  taking  even  fluids,  that  the  patient 
merely  wet  his  lips  to  ease  the  thirst,  but  dared  not  swallow  them. 
He  died  on  October  10th. 

Post-mortem  examination,  twenty-two  hours  after  death. — The 
lungs  were  filled  with  tubercles  in  all  stages;  the  back  part  of  the 
superior  lobe  of  each  lung  contained  several  small  caverns.  Small 
drops  of  pus  exuded  from  the  cut  bronchial  ramifications,  when  the 
lung  was  compressed.  Pericardium  every  where  adherent  to  the 
heart.  Liver  pale  and  greatly  hypertrophied,  adherent  to  the  spleen, 
its  tissue  breaking  down  every  where  under  the  slightest  pressure 
of  the  finger.  The  stomach  contracted  to  the  size  of  the  small 
intestines,  quite  empty,  covered  with  a  black  viscid  secretion ;  its 
coats  thickened  and  hard,  its  mucous  surface  covered  with  dark- 
coloured  patches,  redness  of  the  pyloric  portion. 

Remarks. — In  this  case,  the  patient  was  a  perfectly  healthy  man 
till  the  occurrence  of  the  first  attack  of  inflammatory  indigestion. 
We  perceive  this  disease  to  have  continued,  and  at  length  to  have 
assumed  the  character  of  confirmed  chronic  gastritis.  After  the 
symptoms  of  stomach  disease  had  lasted  for  some  months,  we 
observe  dry  cough  added  to  the  symptoms,  and,  subsequently, 
muco-purulent  expectoration.  In  the  advanced  stages  of  disease, 
the  chief  complaint  made  by  the  patient  was  of  his  stomach,  of  the 
agonising  pain  which  he  endured  till  the  food  he  had  eaten  was 
vomited,  and  the  distress  it  produced  in  adding  to  the  sense  of 
oppression.  The  difficulty  of  breathing  and  the  cough,  with  the 
beneficial  effect  produced  on  the  organs  of  respiration  by  the  local 
depletions  from  the  epigastrium,  and  from  the  remedies  employed 
to  mitigate  the  stomach  disease,  leave  little  room  to  doubt  that  the 
disease  of  the  lungs  was  produced  by  the  prolonged  and  severe 
irritation  existing  in  the  stomach.  I  consider  this  a  well-marked 
case  of  what  has  been  termed  dyspeptic  phthisis.  Louis,  in  his 
work  On  Pulmonary  Consumption,  has  recorded  two  similar 
instances  of  disease  in  the  lung  succeeding  to.  and  evidently  pro- 
duced by,  prolonged  gastric  irritation.  Andral's  Clinique  contains 
another  well-marked  case  of  this  nature. 

"A  young  girl  had  retained,  after  a  profuse  spitting  of  blood,  a 
dry  cough,  and  some  oppression.  She  gradually  lost  flesh ;  she 
had  no  fever,  had  still  some  appetite,  and  attended  to  her  usual 
occupations.  There  was  reason  for  dreading,  in  her  case,  the 
existence  of  pulmonary  tubercles,  but  nothing  afforded  any  cer- 
tainty of  them.  One  day  the  patient  felt  a  pain  in  the  stomach  ; 


144  PARKER  ON  THE  STOMACH. 

she  was  attacked  with  vomiting,  the  tongue  became  red,  fever  was 
lighted  up.     The  second  day  of  the  attack  of  the  inflammation  of 
the  stomach  the  cough  became  more  intense,  and  the  patient,  very 
much  oppressed,  spat  a  considerable  quantity  of  blood.     Under  the 
influence  of  proper  treatment  the  symptoms  of  inflammation  of  the 
stomach  disappeared,  and  at  the  same  time  that  they  improved,  the 
haemoptysis  ceased,  the  cough  became  lighter,  and  the  patient  re- 
turned to  the  same  state  in  which  she  was  before  the  attack  of 
gastritis.     Two  months  after,  the  stomach  disease  again  set  in, 
accompanied  by  the  same  symptoms;   in  a  little  time  after, 
spitting  of  blood  also  manifested  itself.     The  gastritis  again 
minated  favourably,  and  with  it  the  spitting  of  blood  was  obse1 
to  disappear.     The  pulmonary  tubercles  again  seemed  to  rem 
stationary.     Lastly,  at  the  end  of  some  months,  new  symptoms  «. 
inflammation  of  the  stomach  developed  themselves,  and,  as  before 
the  spitting  of  blood  re-appeared  with  marked  increase  of  all  th> 
symptoms  of  disease  in  the  chest.     The  stomach  disease  quick' 
again  disappeared ;  but  this  time  the  symptoms  of  disease  in  t 
chest,  far  from  improving,  became  more   and  more  severe, 
patient  was  soon  brought  to  the  last  stage  of  pulmonary  consun 
tion,  and  died."1 

In  this  case,  although  it  is  probable  that  tubercles  existed  in 
latent  state  in  the  lung,  (for  nothing  indicated  their  existence,)  we 
observe  them  to  remain  stationary  till  the  attack  of  acute  inflamma- 
tion of  the  stomach.  Even  the  two  first  attacks  of  this  disease 
left  the  patient  much  as  she  was  before  their  commencement:  on 
the  occurrence  of  the  third,  the  symptoms  of  phthisis  were  rapidly 
developed,  and  ran  to  a  speedy  termination.  "  From  these  facts  we 
conclude,"  says  the  reporter  of  this  case,  "that  acute  inflammation 
of  the  stomach  which  supervenes,  as  a  complication,  in  the  first 
period  of  pulmonary  consumption,  may  exercise  a  most  mischievous 
influence  on  the  progress  of  the  latter  disease." 

CASE  14.2 — Inflammation  of  the   stomach  producing  cough,  succeeded  by 
tubercular  consumption. 

A  lady,  twenty-two  years  of  age,  born  of  healthy  parents,  had 
complained,  for  about  two  years,  of  a  dull  pain  in  the  region  of  the 
stomach,  when,  after  a  series  of  untoward  circumstances,  her  di- 
gestive powers  became  more  seriously  disturbed.  The  pain  which 
she  suifered  from  taking  food  was  so  great,  that  she  was  reduced 
to  the  necessity  of  living  upon  milk  and  farinaceous  food,  ripe 
fruits,  and  some  kinds  of  vegetables.  If  she  took  more  substantial 
food,  the  gastric  irritation  became  extreme,  and  was  only  relieved 
by  three  or  four  days  of  rigid  abstinence,  and  the  use  of  demulcent 
drinks.  Two  years  from  this  date,  owing  to  great  mental  uneasi- 

1  Clinique  Medicale.  by  Spillan,  p.  519. 
*De  Larroque,  Op.  cit.,  p.  58,  case  10. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.    145 

ness,  the  symptoms  became  acute.  Severe  vomiting  of  green  fluids 
set  in,  with  violent  and  increased  pain  in  the  region  of  the  stomach, 
spasms,  and  cold  perspiration.  This  fresh  attack  yielded  to  the 
same  treatment;  but  now  it  left  behind  it  a  dry  cough,  which  oc- 
casioned so  much  pain  in  the  stomach  that  the  patient,  during  the 
paroxysm,  was  obliged  to  press  the  region  with  a  napkin.  The 
cough,  which  was  at  first  dry  and  by  fits,  was  soon  accompanied 
by  mucous  expectoration  and  slight  pains  in  different  parts  of  the 
chest.  After  these  symptoms  had  continued  three  months,  the 
expectoration  assumed  a  purulent  character;  the  cough  was  not 
more  frequent,  but  it  produced  still  increasing  pain  in  the  stomach, 
over  which  region  the  slightest  pressure  caused  pain  so  severe  that 
the  patient  could  not  forbear  crying  out.  The  point  of  the  tongue 
was  red,  the  respiration  hurried,  the  percussion  of  the  chest  obscure, 
whilst  there  was  an  inability  to  recline  on  either  side.  The 
patient  now  became  hectic,  had  night  perspirations  and  slight  diar- 
rhoaa,  and  died  at  the  end  of  a  month  from  the  date  of  the  account 
of  the  last  symptoms. 

Post-mortem  examination. — The  right  lung  contained  several 
small  caverns,  and  a  number  of  tubercles  not  yet  softened;  the  left 
lung  hepatised,  red,  and  adherent  to  the  parietes  of  the  chest ;  the 
mucous  membrane  of  the  bronchiae  slightly  injected.  The  mucous 
coat  of  the  stomach  was  covered  by  a  false  membrane,  similar  to 
that  observed  occasionally  in  the  mouth;  under  this  membrane,  it 
was  of  a  deep  violet  colour,  which  deepened  towards  the  pyloric 
portion.  The  duodenum  and  small  intestines  presented  traces  of 
inflammation. 

Remarks. — On  reviewing  the  history  of  this  case,  we  find  the 
symptoms  of  gastric  derangement,  arising  from  a  series  of  moral 
impressions,  preceding  the  symptoms  of  pulmonary  irritation  for 
two  years.  It  was  not  till  the  attack  of  acute  inflammation  that 
the  disease  of  the  stomach  became  complicated  with  cough  and 
pain  in  the  chest.  The  cough,  by  its  violence,  added  to  the  distress 
of  the  patient  and  the  uneasiness  already  existing  in  the  stomach. 
We  note  again,  that  the  cough  was  at  first  dry,  resembling  that 
which,  in  a  great  number  of  instances,  accompanies  various  forms 
of  stomach  derangement,  whether  of  the  inflammatory  or  saburral 
kind ;  soon  afterwards,  it  is  followed  by  mucous,  and  subsequently 
with  purulent  expectoration,  whilst  other  symptoms,  indicating  the 
extension  of  disease  from  mere  nervous  irritation  to  organic  change, 
make  their  appearance.  The  commencement  and  progress  of  this 
case,  lead  us  to  place  the  origin  of  the  pulmonary  disease  in  the 
stomach. 

12— b  park  10 


146 


PARKER    ON  THE  STOMACH. 


CASE  15.'— Chronic  inflammation  of  the  stomach,  with  diarrhoea,  preceding 
the  symptoms  of  disease  in  the  chest  for  eleven  months. — Termination 
in  pulmonary  phthisis. 

A  man,  aged  thirty-four  years,  entered  the  hospital  of  La  Charite, 
complaining  of  having  been  indisposed  for  a  year  and  a  half.  He 
had  not  b£en  able  to  follow  his  usual  occupation  for  five  months: 
and  attributed  the  origin  of  his  complaint  to  severe  mental  distress, 
occasioned  by  some  pecuniary  losses.  The  disease  had  commenced 
with  total  loss  of  appetite  and  looseness  of  the  bowels.  He  had 
neither  had  nausea,  vomiting,  or  fever,  but,  with  the  symptoms 
before  complained  of,  some  pains  in  the  region  of  the  stomach. 
Suddenly,  and  without  any  evident  cause,  he  was  seized  in  the 
night  with  spitting  of  blood,  to  the  amount  of  half  a  pint;  this 
came  on  again  two  days  afterwards:  it  yielded  to  the  exhibition  of 
acidulated  drinks.  Cough,  with  expectoration,  difficulty  of  breath- 
ing, and  vomiting,  succeeded;  the  diarrhoea  ceased.  From  this 
period  the  patient  continued  weak,  and  the  pulse  small,  feeble,  and 
slightly  accelerated;  exacerbation  of  fever  in  the  evening,  night 
perspirations.  The  respiration  approached  the  cavernous  character 
at  the  summit,  and  round  the  whole  of  the  chest  on  the  left  side. 
Slight  expectoration,  with  considerable  emaciation.  A  month  after- 
wards the  nausea  and  vomiting  ceased,  and  the  digestion  was  im- 
proved; the  difficulty  of  breathing  was  also  much  amended:  the 
patient,  however,  continued  very  weak.  The  cough  and  vomiting 
again  re-appeared,  and  the  appetite  again  became  bad.  During  the 
remaining  period  of  his  existence  the  appetite  continued  variable; 
diarrhoea  set  in  once,  but  was  speedily  checked.  The  patient  con- 
tinued to  sink,  and  died  with  the  physical  symptoms  of  the  soften- 
ing of  tubercles  six  weeks  after  the  last  relapse. 

Post-mortem  examination. — The  superior  lobe  of  the  left  lung 
contained  two  large  caverns  at  its  summit,  whilst  in  other  parts  of 
the  substance  of  this  lobe  smaller  caverns,  partially  emptied  of 
tuberculous  matter,  existed.  The  inferior  lobe  contained  also  some 
crude  tubercles.  On  the  right  side  the  same  kinds  of  lesion  were 
found,  but  to  a  less  extent.  The  mucous  membrane  of  the  trachea 
and  bronchias  was  inflamed,  and  had  small  ulcerations  in  parts. 
The  mucous  membrane  of  the  stomach  was  of  a  yellow  colour  in 
its  cardiac  portion,  more  or  less  gray  over  the  remaining  part  of  its 
surface;  the  gray  colour  was  interrupted,  in  certain  points,  by  small 
white  patches,  where  the  mucous  membrane  was  considerably 
thinner  than  in  the  natural  state.  A  small  ulcer  existed  midway 
between  the  cardia  and  pylorus.  Ulcerations  in  the  small  and 
large  intestines. 

Remarks. — In  analysing  the  progress  of  the  symptoms  in  this 
case,  we  observe  it  to  have  commenced  in  mere  indisposition,  the 

1  Louis,  Recherches  sur  la  Phthisic,  p.  326,  Case  21. 


INFLUENCE  OP  ITS  MORBID  STATES  ON  THE  LUNGS.          147 

result  of  grief  from  pecuniary  loss;  this  indisposition  is  marked  by 
loss  of  appetite,  pain  in  the  stomach,  and  diarrhoea,  the  ordinary 
symptoms  and  concomitants  of  various  forms  of  what  is  called 
indigestion.  "At  this  period,"  remarks  Louis,  the  affection  of  the 
lung  did  not  appear  to  be  in  existence."  Suddenly  spitting  of 
blood  occurs,  the  breathing  becomes  bad,  and  cough,  with  expecto- 
ration, appears ;  at  the  same  time  the  stomach  symptoms  become 
more  serious,  vomiting,  which  had  not  previously  been  present,  is 
added  to  the  pain  in  the  stomach  and  the  loss  of  appetite.  We 
observe  the  patient  to  amend  after  this,  although  he  still  continued 
weak;  suddenly  the  vomiting  again  set  in,  with  the  cough,  and  the 
symptoms  of  disease  in  the  chest  became  aggravated.  From  this 
period  the  patient  continued  to  sink,  with  all  the  physical  and 
rational  signs  of  disease  in  the  lungs.  We  note  the  most  remark- 
able features  in  this  case:  that  the  dyspeptic  symptoms  (the  result 
of  mental  uneasiness,  which  so  commonly  produces  such  symptoms) 
were  in  existence  eleven  months  before  the  least  appearance  of  dis- 
ease in  the  chest  was  evident,  or  before  even  it  was  suspected;  and, 
again  we  remark  both  the  first  attack  of  spitting  of  blood,  and  his 
relapse  after  partial  recovery,  to  have  been  accompanied  with  an 
increase  in  the  symptoms  of  the  disease  in  the  stomach,  marked  by 
the  vomiting  which  accompanied  both  these  occurrences.  The 
state  of  the  stomach  after  death,  sufficiently  accounts  for  the  phe- 
nomena observed  during  life.  In  this  case  it  certainly  appears  that 
the  disease  in  the  chest  was,  in  the  first  instance,  produced  by  the 
gastric  irritation,  which  terminated  in  ulceration  of  the  coats  of  the 
stomach.  The  relapse,  which  ultimately  proved  fatal,  also  appears 
to  have  been  owing  to  an  increase  in  the  severity  of  the  stomach 
disease. 


RECAPITULATION  AND  GENERAL  HISTORY  OF  DISEASES  OF  THE 
STOMACH,  IN  THEIR  INFLUENCE  UPON  THE  ORIGIN,  PROGRESS, 
AND  TERMINATION  OF  DISEASES  IN  THE  LUNGS. 

In  the  detail  of  the  preceding  cases,  we  have  seen  that  an  in- 
flamed or  irritable  condition  of  the  mucous  membrane  of  the  stomach 
and  bowels  exercises  a  marked  influence  upon  the  condition  of 
the  lungs  and  their  appendages,  whether  in  reference  to  mere  func- 
tional derangements  in  the  organs  of  respiration,  or  in  the  produc- 
tion of  various  forms  of  hyperemia  and  inflammation,  which,  in 
many  instances,  terminate  in  incurable  organic  disease. 

We  shall  first  enquire  into  the  nature  of  the  symptoms  which 
indicate  the  commencement  of  pulmonary  irritations,  which  depend 
on  an  inflamed  condition  of  the  lining  membrane  of  the  stomach. 
Two  of  the  most  common  symptoms  which  denote  the  commence- 
ment of  affections  of  the  lung  arising  from  this  cause  are,  a  pain 


148  PARKER  ON  THE  STOMACH. 

in  the  centre  ot  the  sternum,  with  a  sense  of  constriction   and 
oppression  across  the  chest,  and  cough  coming  on  after  eating. 

We  sometimes  find  persons  who  have  no  appetite,  a  foul  tongue, 
a  disposition  to  a  relaxed,  and  at  other  times  to  a  constipated,  condi- 
tion of  the  bowels,  complaining  of  pain  and  oppression  in  the  centre 
of  the  sternum  and  fore  part  of  the  chest,  with  a  dry,  irritating 
cough,  which  becomes  invariably  aggravated  by  a  meal. 

The  epigastrium,  in  many  cases  of  this  kind,  is  not  at  all  sen- 
sible to  pressure:  it  may  be  handled  and  pressed  without  any  un- 
easiness being  produced.  In  other  instances,  however,  epigastric 
tenderness  co-exists,  but  it  is  not  essential  to  the  existence  of  chro- 
nic gastritis  or  hyperernia  that  it  should  do  so.  I  met  with  a 
remarkable  case  of  this  kind  in  a  gentleman  who  had  occasionally 
been  seized  with  violent  sicknesses" and  diarrhoea,  at  long  intervals, 
during  a  period  of  three  or  four  years.  These  were  soon  removed, 
but  the  tongue  remained  constantly  foul ;  and  though  the  patient 
took  food  he  had  never  any  appetite  for  it.  He  was  neither  well 
nor  ill,  had  a  sallow  cast  of  countenance,  and  always  a  disposition 
to  relaxed  bowels,  with  a  dry  cough,  becoming  worse  after  dinner. 
His  food  never  disagreed  with  him,  never  caused  him  pain,  was 
never  vomited,  except  at  the  periods  mentioned,  and  he  never  felt 
sick;  yet  I  was  convinced  this  patient  was  suffering  from  chronic 
gastritis,  and  felt  assured  that,  sooner  or  later,  it  would  manifest 
itself  in  some  marked  form,  as  he  lived  freely.  I  met  him  by  ac- 
cident one  day,  and  he  complained  of  pain  in  the  chest,  with 
oppression,  and  increased  cough ;  in  all  other  points  he  remained 
much  the  same.  In  the  evening  of  that  day  acute  inflammation  of 
the  stomach  came  on ;  the  epigastrium,  before  indolent,  was  now  so 
sensible  that  he  could  not  bear  a  finger  upon  it,  the  tongue  was 
become  vividly  red,  whilst  the  pain  in  the  chest  and  oppression 
were  so  great  that  he  could  not  breathe  without  difficulty;  at  the 
same  time,  the  bowels,  which  were  before  relaxed,  became  obsti- 
nately costive.  From  freely  leeching  the  epigastrium  for  four  or 
five  days,  the  tongue  became  clean,  which  it  had  not  been  for 
twelve  months,  and  all  the  symptoms  of  thoracic  disease,  cough 
and  pain,  were  removed. 

In  other  forms  of  disease,  the  acute  form  of  inflammation  of  the 
stomach  is  never  assumed.  Thus  we  see,  in  delicate  females,  the 
cough  after  food,  with  pains  in  the  chest,  masking  all  the  symptoms 
of  gastric  disturbance,  which  are  often  obscure,  continue  month 
after  month,  with  progressive  emaciation.  If  auscultation  be  not 
understood  by  the  practitioner  in  attendance,  it  is  difficult,  nay,  im- 
possible, to  determine  whether  the  disease  be  pulmonary  or  not. 
It  is  concluded  that  it  is  so,  since  the  symptoms  of  such  disease  are 
well  marked,  stimulant  expectorants,  or  tonics,  are  resorted  to, 
which  only  aggravate  the  symptoms,  and  the  patient  sinks  from  a 
suspected  chest  affection,  which,  on  examination  after  death,  is 
found  not  to  exist,  and  the  seat  of  the  disease  is  found  to  be  the 
stomach.  Broussais'  cases  are  examples  of  errors  of  this  kind:  he 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.    149 

was  deceived  in  all  three  cases,  merely  suspecting  that  the  disease 
which  appeared  bronchial,  in  the  last  case,  might  possibly  be 
gastric.  The  first  case  of  the  fifteen  given  in  this  part  of  the  work 
is  a  well-marked  example  of  the  irritation  which  arises  in  the  lungs, 
the  consequence  of  inflammation  of  the  stomach,  whilst  the  proper 
and  customary  symptoms  of  the  gastric  disease  are  masked  or  alto- 
gether absent.  Many  of  the  cases  of  gastritis  recorded  by  M.  de 
Larroque,  in  his  work  on  Diseases  of  the  Abdomen  which  simulate, 
produce,  or  keep  up  Diseases  of  the  Chest,  were  marked  by  this 
peculiar  symptom  of  dry  cough,  increased  by  taking  food. 

Accelerated  respiration  is  another  symptom  observed  in  the  func- 
tions of  the  lungs,  which  is  dependent  on  disease  in  the  stomach. 
In  many  cases,  even  where  cough,  pain,  and  tightness  exist  in  the 
chest,  the  number  of  respirations  are  not  at  all  quickened  :  the 
patient  can  inspire  deeply  without  pain,  or  without  increasing  the 
cough.  But  in  other  instances  the  breathing  is  quickened  :  there 
is  a  peculiar  catching  at  the  breath,  a  deep  inspiration  occasions 
pain,  and  brings  on  cough.  These  symptoms,  still  more  than  those 
we  have  been  considering,  appear  to  indicate  pulmonary  disease ; 
yet  still  these  are  found  to  depend  on  gastric  inflammation,  and  no 
physical  sign  of  disease  in  the  lung  can  be  observed  to  account  for 
the  production  of  these  symptoms.  We  have  commonly  observed 
children  to  be  suddenly  seized  with  fever  and  short  breathing,  pre- 
cisely resembling  the  rational  signs  of  pneumonia  ;  yet,  in  analysing 
the  state  of  the  organs  in  the  chest  and  belly,  I  have  been  convinced 
that  this  hurried  breathing,  with  catching,  when  the  diaphragm 
was  depressed  by  an  inspiration,  depended  upon  inflammation  of  the 
mucous  coat  of  the  stomach,  and  not  upon  any  lesion  of  the  organs 
of  respiration.  Sometimes,  in  these  cases,  children  will  complain 
of  pain  in  the  belly  ;  at  others  there  may  be  vomiting  present ;  or 
diarrhoea,  with  green,  frothy,  offensive,  or  parti-coloured  evacuations. 
Again,  all  these  signs  may  he  absent,  the  difficulty  of  breathing  pre- 
sent, yet  no  physical  sign  indicating  an  affection  of  the  lung!  In 
such  instances  I  agree  with  De  Larroque  that  the  vivid  redness  of 
the  point  and  edges  of  the  tongue,  with  the  general  fever,  are  the 
chief  indications  of  gastric  inflammation.  I  have  noted  numbers  of 
these  cases  occurring  in  children,  continuing  fora  shorter  or  greater 
length  of  time,  and  exasperated  or  not  amended  by  medical  treat- 
ment, cease  promptly  on  the  application  of  one  or  two  relays  of 
leeches  to  the  epigastrium. 

The  chief  symptoms,  then,  of  the  commencement  of  pulmonary 
irritation,  as  a  consequence  of  gastric  disease,  are  dry  cough,  in-  ' 
creased  by  food  during  digestion,  and  by  stimuli ;  pain  on  some 
point  of  the  thoracic  parietes,  oppression,  constriction  of  the  chest, 
with  accelerated  or  irregular  respiration.  These  may  exist  with 
gastric  irritation,  and  without  any  evident  affection  of  the  lung  to 
account  for  them;  or  they  may  be  found  with  both  pulmonary  and 
stomach  disease.  We  will  enquire  for  a  moment  into  the  mode  of 
their  production. 


150  PARKER  ON  THE  STOMACH. 

When  inflammation  of  the  mucous  coat  of  the  stomach  becomes 
a  source  of  irritation  to  the  lungs,  it  may  be  propagated  in  several 
ways;  1.  The  existence  of  dry  cough  with  irregular  states  of  the 
respiration  appears  to  depend  on  irritation  of  the  gastric  extremities 
of  the  pneumo-gastric  nerve.  In  some  instances  of  this  kind 
Lobstein  has  found  the  branches  of  this  nerve  inflamed.1  In  other 
forms  the  trunk  of  these  nerves  was  enlarged  and  hypertrophied  to 
a  great  extent,  as  in  the  fourth  and  fifth  cases  of  cancer  of  the  sto- 
mach related  by  Dr.  Lombard  of  Geneva.2  In  most  instances  of 
this  kind  the  disease  appears  limited  to  mere  irritation  of  the  pul- 
monary branches  of  this  nerve,  2.  Irritation  may  be  propagated 
from  the  stomach  to  the  lungs,  in  accordance  with  that  law  which 
disposes  diseases  to  spread  by  similarity  of  tissue  ;  and  thus  we  find, 
after  death  from  gastric  inflammation,  accompanied  by  cough  or 
other  symptoms  of  derangement  in  the  organs  of  respiration  a 
pinky,  congested,  or  inflamed  state  of  the  bronchial  mucous  mem- 
branes. This  explains  also  the  bloody  expectoration  observed 
during  acute  forms  of  gastritis,  and  the  profuse  hemoptysis  to 
which  they  sometimes  give  origin,  which  in  many  instances,  marks 
the  first  invasion  of  phthisis.  This  bloody  expectoration  was  well 
marked  in  the  fourth  case;  and  an  example  of  hemoptysis  thus  pro- 
duced, and  terminating  ultimately  in  phthisis,  is  exemplified  in  a 
case  quoted  from  Andral  in  the  notes  to  the  thirteenth  case,  one  of 
phthisis  succeeding  to  inflammation  of  the  stomach.  3.  The  affec- 
tion of  the  chest  may  depend  upon  an  inflamed  condition  of  the 
peritoneum  lining  the  inferior  surface  of  the  diaphragm.  De 
Larroque  has  reported  a  case,  in  which  such  a  condition  of  the 
diaphragm,  coincided  with  severe  gastric  inflammation. 

Where  the  affection  of  the  lung  commences  as  it  most  commonly 
does,  in  mere  nervous  irritation,  it  does  not  long  continue  in  this 
form,  since  the  violent  fits  of  coughing  and  the  continuance  of  irri- 
tation ultimately  induce  a  congested,  and  subsequently  an  inflamed, 
condition  of  the  mucous  membrane  of  the  bronchiae,  of  the  substance 
of  the  lungs,  or  the  pleura.  We  have  examples  of  most  of  these 
states  coinciding  with,  or  succeeding  to,  gastric  diseases,  in  the 
detail  of  the  preceding  cases.  Thus,  in  some  were  observed  a  true 
bronchitis;  in  others,  a  congested  state  of  the  lung,  without  inflam- 
mation ;  whilst,  again,  the  signs  of  pneumonia  were  present.  These 
facts  teach  us  to  note  well  the  progress  of  the  symptoms,  both 
physical  and  rational,  which  accompany  cough  and  disordered  res- 
piration evidently  of  gastric  origin,  since,  in  many  forms,  the  dis- 
ease in  the  lung  is  not  limited  to  mere  nervous  irritation,  but  quickly 
and  insidiously  progresses  into  various  inflammatory  affections, 

1  De  Nervi  Sympathetici  Fabrica,  Usu,  et  Morbis,  Commentatio,  &c.,  p. 
152,  153,  154. 

2  "Clinique  Medicale  de  l'H6pital  Civil  et  Militaire  de  Geneve,"  par  H. 
C.  Lombard. — Gazette  Medicale  de  Paris,  Janvier,  1837. 


INFLUENCE    OF    ITS    MORBID    STATES    ON    THE    LUNGS.       151 

which,  if  there  he  a  tubercular  tendency,  may  ultimately  degenerate 
into  phthisis. 

It  happens,  in  many  instances,  that  cough,  disordered  respiration, 
and  progressive  wasting-,  the  result  of  chronic  inflammatory  disease 
of  the  stomach,  exist  without  any  physical  sign  of  disease  in  the 
lung  being  present,  upon  which  these  symptoms  can  be  said  to 
depend ;  and  although  the  affection  may  very  much  resemble 
organic  disease  of  the  lung,  yet  the  stethoscopic  signs  afforded  by 
examination  of  these  organs  at  once  convince  us  that  they  are  free 
from  complaint  (Cases  1,  2).  In  these  cases  it  is  easy  to  ascertain, 
that  this  affection  of  the  chest  is  dependent  upon  the  condition  of 
the  stomach,  by  the  symptoms  of  disease  which  the  latter  organ 
presents,  in  the  state  of  the  tongue,  of  the  digestive  powers,  and  that 
of  the  epigastrium.  In  circumstances,  however,  where  we  are  not 
called  to  ihe  patient  till  late  in  the  disease,  where  the  primitive 
state  of  irritation  in  the  lung  has  proceeded  to  one  of  inflammation 
or  its  consequences,  and  these  coincide  with  a  marked  diseased  con- 
dition of  the  stomach  and  other  organs  concerned  in  the  digestive 
process,  it  becomes  a  matter  of  great  difficulty  to  ascertain  in  which 
organ  disease  has  at  first  commenced. 

Inflammatory  diseases  of  the"  stomach,  which  complicate  those  of 
the  lungs,  may  originate  simultaneously  with  the  affection  of  the 
chest,  and  from  the  same  cause.  The  disease  of  the  stomach  may 
be  primitive,  and  that  of  the  lungs  secondary;  or  the  disease  of  the 
stomach  may  succeed  to  that  of  the  lungs.  But,  at  whatever  period 
the  affection  of  the  digestive  organs  may  have  appeared,*  it  is  not 
less  influential  in  its  effects  upon  the  organs  contained  in  the  chest. 
This  remark  derives  support  from  the  history  of  the  preceding 
cases,  but  more  particularly  from  the  1st.  2d,  10th,  llth,  and  13th 
cases. 

I  was  requested  to  see  a  lady,  aged  22,  who  laboured  under  the 
following  symptoms: — great  difficulty  of  breathing,  constant  pain 
in  the  epigastrium,  aggravated  by  pressure,  uneasiness  after  food 
terminating  in  vomiting,  universal  "rale  sonore"in  all  points  of  the 
chest,  alternating  in  places  with  the  sibilant  and  mucous  rales. 
This  was  evidently  subacute  inflammation  of  the  stomach,  occurring 
at  the  same  time  with  a  similar  condition  of  the  mucous  membrane 
of  the  lungs.  Leeches  were  ordered  to  the  epigastrium,  and  a 
combination  of  the  ponderous  carbonate  of  magnesia  administered 
with  Dover's  powder,  in  the  proportions  of  half  a  dram  of  the 
former  to  five  grains  of  the  latter,  three  times  a  day.  No  other 
treatment  was  employed,  and  under  this  she  speedily  recovered. 
Dr.  Copland  has  alluded  to  the  frequent  simultaneous  occurrence 
of  disease  in  the  mucous  membrane  of  the  lungs  and  that  of  the  sto- 
mach.1 These  complications,  also  frequently  pass  from  the  subacute 
to  the  chronic  slate  together;  thus  we  often  see.  more  particularly 
in  children,  diarrhcea,  with  vomiting,  accompanying  cough,  quick- 

1  Dictionary  of  Practical  Medicine,  p.  253.  and  note. 


152  PARKER  ON  THE  STOMACH. 

ened  breathing,  and  the  physical  signs  of  bronchial  disease.  In 
such  instances,  all  remedies  calculated  to  excite  the  digestive  mucous 
surfaces  should  be  avoided,  particularly  all  forms  of  antimonial 
remedies  with  squills,  and  the  usual  syrups  or  balsams,  since  they, 
by  adding  to  the  irritation  already  existing  in  the  stomach,  are  more 
likely  to  increase  than  diminish  the  co-existing  affections  of  the 
chest.  I  have  generally  found  in  such  states  the  mist,  cretse,  with 
the  opiate  confection  and  hydrocyanic  acid,  or  a  combination  of 
hyd.  c.  creta  with  pulv.  ipecac,  co.,  succeed  better  than  any  other 
remedies,  at  the  same  time  leeching  the  epigastrium,  if  the  gastric 
symptoms  are  urgent,  or  using  counter-irritants  to  the  chest  with 
local  depletion,  if  the  pectoral  symptoms  become  predominant.  The 
digestive  mucous  surfaces  must  not  be  irritated.  I  cannot  too  fre- 
quently press  upon  the  reader  the  importance  of  this,  since  their 
sympathies  with  the  lungs  in  so  many  forms  of  chest  disease  are  so 
marked,  as  we  shall  still  further  see  in  their  complication  with 
various  forms  of  pneumonia. 

In  some  forms  of  inflammation  of  the  mucous  coat  of  the  stomach, 
which  produce  disease  in  the  lungs,  we  observe,  as  in  case  3,  the 
affection  of  the  stomach  to  cease  after  the  establishment  of  disease  in 
the  chest,  terminating  in  profuse  expectoration.  Andral  has  noticed 
the  alternation  of  disease  between  the  lungs  and  intestinal  tube,  in 
certain  forms  of  inflammation.  He,  as  I  have  done  in  the  remarks 
on  that  case,  considers  the  secondary  disease  to  act  by  way  of  re- 
vulsion upon  the  first.1  Thus  as  in  the  third  case,  the  affection 
of  the  stomach,  which  had  not  yielded  to  remedies,  diminished 
when  the  disease  in  the  chest  was  fully  established,  and  ceased 
altogether  when  free  expectoration  set  in.  Inflammatory  affections 
of  the  stomach  in  this  way  occasionally  relieve  similar  forms  of  dis- 
ease in  the  lungs.  We  must  not.  however,  attempt  to  imitate,  by 
artificial  means,  these  inflammations  of  the  digestive  surfaces,  which 
occasionally  seem  to  relieve  the  disease  in  the  chest  when  they 
occur  subsequently  to  the  affections  of  the  lungs,  since,  in  a  great 
majority  of  instances,  the  cough  and  expectoration  are  increased  by 
the  inflammation  of  the  stomach  and  bowels,  and  the  difficulty 
of  breathing,  more  particularly,  becomes  aggravated,  as  we  may 
observe  by  perusing  the  details  of  the  tenth,  eleventh,  and  twelfth 
cases. 

Occasionally  the  symptoms  of  chronic  inflammation  of  the  sto- 
mach are  accompanied  by  dull  pains  in  either  of  the  sides,  under 
the  mammae,  or  in  the  cardiac  region.  At  times,  these  pains  become 
suddenly  acute,  and  when  accompanied  by  cough  and  inability  to 
dilate  the  chest  for  free  inspiration,  they  have  the  character  of 
pleurisy.  I  have  never  seen  these  pains,  when  occurring  with 
marked  symptons  of  stomach  derangement,  exhibit,  on  examination, 
any  of  the  physical  signs  of  pleurisy,  although  they  have  con- 
tinued for  weeks,  or  even  months,  and  in  some  instances  are  never 

1  Clinique  Medicale,  by  Spillan,  p.  529. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.     153 

absent  during  the  continuance  of  the  stomach  disease.  Sometimes 
irregular  action  of  the  heart,  with  intermittent  pulse,  is  attendant  on 
these  thoracic  pains.  I  have  seen  leeches  and  blisters  applied  over 
the  seat  of  pain  fail  in  giving  relief,  when  the  stomach  has  not  been 
attended  to;  whilst,  again,  local  depletion  from  (he  epigastrium, 
with  the  exhibition  of  the  hydrocyanic  acid,  or  other  remedies 
suited  to  the  particular  features  of  the  stomach  affection,  have  seldom 
failed  in  relieving  these  sympathetic  pains.  Cases  8  and  9  are 
examples  of  these  forms  of  disease.  I  have  seen  similar  acute 
pains  seated  on  the  scalp,  resisting  every  mode  of  local  treatment, 
yield  only  to  remedies  calculated  to  remove  the  gastric  disturbance 
upon  which  they  depended. 

I  have  shown,  in  the  details  of  the  tenth,  eleventh,  and  twelfth 
cases,  that  pneumonia  is  frequently  complicated  with  inflammation 
of  the  mucous  coat  of  the  stomach.  This  complication  was  first 
described  by  Stoll,  under  the  term  " bilious  pneumonia:"  it  is  a 
complication  of  a  saburral,  irritative,  or  inflammatory  state  of  the 
stomach,  with  inflammation  in  the  substance  of  the  lungs,  the  affec- 
tion of  the  stomach  being  characterised  by  nausea,  vomiting,  a  loaded 
tongue,  red  at  its  point  and  edges,  yellow  tinge  of  the  countenance 
and  conjunctive,  with  pain  and  tenderness  in  the  epigastrium; 
whilst  in  the  lungs  the  physical  symptoms  of  pneumonia  are  present. 
The  disease  in  the  lung  may  be  subsequent  to,  and  dependent  upon, 
the  gastritis,  or  the  two  may  be  ushered  in  together.  I  remember 
being  called  to  attend  a  person  who,  in  a  state  of  intoxication,  had 
laid  down  upon  the  grass  and  fallen  asleep.  Previous  to  this  occur- 
rence he  had  been  in  the  most  robust  health;  he  did  not  remember 
ever  to  have  been  sick,  and  had  never  had  a  cough  or  shortness  of 
breath.  On  the  next  morning  he  was  seized  with  acute  pain  in  the 
stomach,  with  constant  vomiting  of  every  thing  he  swallowed.  This 
continued  to  increase  for  ten  days  ;  at  the  end  of  that  time  I  first  saw 
him.  He  had  then  acute  pain  in  the  epigastrium,  increased  to 
agony  by  pressure  ;  incessant  vomiting,  cough,  short  breathing,  con- 
striction and  pain  across  the  chest.  On  examining  the  chest,  the 
respiration  was  absent  in  the  middle  and  inferior  parts  of  the  right 
lung,  except  that  here  and  there  the  slightest  murmur  was  detected; 
in  the  apex  of  the  same  lung  it  was  more  distinct.  He  was  bled  in 
the  arm :  the  blood  presented  the  usual  characters  of  inflammation. 
Leeches  were  applied,  also,  to  the  stomach,  and  he  took  an  occa- 
sional dose  of  calomel  and  opium.  By  a  perseverance  in  the  local 
depletion  from  the  epigastrium,  and  opiates  from  time  to  time,  the 
gastric  disturbance  was  so  far  subdued  as  to  enable  him  to  retain 
the  milder  kinds  of  food  upon  his  stomach  ;  but  the  short  breathing, 
with  cough  and  frequency  of  pulse,  (one  hundred  and  twenty,)  con- 
tinued. I  saw  the  patient  at  intervals,  for  twelve  months;  during 
this  time  his  state  continued  much  the  same ;  the  cough,  the  diffi- 
culty of  breathing,  the  absence  of  respiration  in  the  greater  part  of 
the  right  lung  (to  which  was  now  added  dulness  on  percussion) 
continued,  with  attacks  of  severe  vomiting  whenever  any  errors  in 


154  PARKER  ON  THE  STOMACH. 

diet  were  committed.  I  noted  his  state  particularly,  thirteen  months 
after  the  commencement  of  the  acute  disease,  it  was  as  follows: — 
September  28th,  1S35.  In  the  superior  lobe  of  the  right  lung  the 
respiratory  murmur  was  audible,  absent  in  the  middle  and  inferior; 
dulness  on  percussion,  hoarseness,  occasional  loss  of  voice,  constant 
acidity,  nausea,  with  vomiting  almost  daily.  The  pulse  intermits, 
but  there  is  no  evident  affection  of  the  heart.  He  has  derived 
great  benefit  lately  from  the  application  of  four  or  six  leeches  to 
the  epigastrium,  and  taking  internally  the  ponderous  carbonate  of 
magnesia  with  the  compound  powder  of  ipecacuanha.  All  the 
complaint  is  of  the  stomach  ;  and  in  proportion  to  the  relief  afforded 
to  the  gastric  symptoms  is  there  amendment  in  the  short  breathing 
and  hoarseness. 

In  some  instances,  the  pneumonia  may  succeed  to  the  gastritis ; 
but  in  all  instances  where  there  is  a  complication  of  these  diseases, 
the  contra-stimulant  treatment  of  inflammation  of  the  lungs  by  the 
antirnonium  tartarizatum  is  inadmissible.  A  medical  friend,  in  my 
absence,  observing  the  marked  symptoms  of  chest  disease  of  the 
inflammatory  character  in  the  last  case,  administered  the  sixth  of 
a  strain  of  this  remedy,  three  times  a  day,  to  the  subject  of  it ;  the 
aggravated  state  of  the  gastric  symptoms,  consequently  developed, 
was  so  great  that  there  was  some  difficulty  in  subduing  them, 
while  the  respiration  became,  under  its  use,  still  more  embarrassed. 
We  observe  the  ill  effects  of  its  exhibition  in  the  history  of  the 
twelfth  case,  where  the  fatal  issue  was,  doubtless,  hastened  by  its 
use.  The  general  and  local  abstraction  of  blood,  with  subsequent 
counter-irritation  on  the  surface  of  the  chest,  are  the  only  means 
left  to  us  to  combat  inflammatory  affections  of  the  lungs,  thus  com- 
bined with  similar  conditions  of  the  gastric  mucous  membranes. 
The  tenth  and  eleventh  cases  cannot  be  too  attentively  studied. 
In  both  these  instances  the  general  bleeding,  as  well  as  that  locally 
employed  from  the  surface  of  the  chest,  appeared  to  have  some 
effect  upon  the  inflammation  of  the  lung;  but  still  the  disordered 
respiration  was  not  relieved.  This  might  depend  as  much  upon 
the  gastritis  as  the  pneumonia;  for  we  observe  it  yield,  in  a  marked 
manner,  to  local  bleeding  from  the  epigastrium.  It  is,  again,  ex- 
tremely probable,  from  what  we  have  seen  of  the  influence  of  the 
stomach  upon  the  lungs,  that  the  gastritis  itself  would,  by  the  irri- 
tation it  occasioned  in  the  chest,  act  as  a  stimulus  in  keeping  up 
the  pneumonia;  certainly  the  inflammatory  symptoms  in  the  lungs 
yielded  much  more  quickly  after  the  gastric  symptoms  had  been 
subdued. 

Cases  13  and  14  are  examples  of  tubercular  phthisis,  developed 
after  continued  gastric  irritation.  The  work  of  Louis  contains  two 
cases  of  this  kind  ;  that  of  De  Larroque  two.  Andral  also  men- 
tions the  history  of  one  or  two  cases  of  tubercular  disease  of  the 
lung,  succeeding  to  a  continued  inflammatory  condition  of  the 
stomach.  I  have  myself  seen  four  examples  of  inflammation  of  the 
stomach,  commencing  in  the  symptoms  of  inflammatory  indiges- 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  LUNGS.    155 

tion,  and  thence  progressing  into  confirmed  chronic  gastritis,  ter- 
minate, at  periods  of  an  earlier  or  later  date,  in  true  tubercular 
phthisis.  I  have  given,  in  Case  13,  a  detail  of  one  of  these  cases. 
In  that  case,  the  treatment  directed  to  the  stomach  alone  exercised 
a  marked  influence  over  the  more  distressing  symptoms  connected 
with  the  pectoral  disease.  The  occurrence  of  repeated  attacks  of 
inflammatory  indigestion  or  of  diarrhoea  in  persons  exhibiting  any 
predisposition  to  affections  of  the  chest,  or  where  there  is  any 
hereditary  tendency  to  phthisis,  should  excite  our  most  watchful 
attention.  If  we  analyse  the  symptoms  of  every  case  of  indiges- 
tion not  amounting  to  a  chronic  gastritis,  even  in  its  faintest  shade, 
which  comes  before  us,  we  shall  find  a  great  majority  complicated, 
in  a  greater  or  less  degree,  with  cough.  Fulness  of  blood  in  the 
coats  of  the  stomach,  or  an  exalted  state  of  the  sensibility  of  its 
nerves,  has  a  particular  tendency  to  the  production  of  this  symp- 
tom. In  some  it  follows  a  meal,  and  continues  during  the  period 
of  digestion;  in  others,  pressing  the  epigastrium  will  produce  it; 
in  a  third  series,  dry,  short  cough  is  constantly  present. 

I  know  not  whether  a  morbid  sensibility  to  impression  in  the 
mucous  surfaces  of  the  stomach  is  accompanied  by  a  similar  con- 
dition of  the  same  parts  in  the  lung;  but  I  am  certainly  inclined 
to  such  a  view  of  the  subject.  "  We  are  convinced  by  observa- 
tion," says  Andral,  "that  persons  affected  with  chronic  enteritis, 
have  a  fatal  tendency  to  pulmonary  phthisis.  We  think  we  should 
never  neglect,  by  active  means,  to  combat  the  colds  with  which 
they  are  affected,  however  slight  they  may  appear.  Too  often,  in 
this  case,  temporising  has  been  fatal ;  in  consequence  of  it,  a  slight 
bronchitis  has  rapidly  given  rise  to  numerous  tubercles.  It  is  cer- 
tainly a  matter  of  every-day  occurrence  to  witness  persons  who 
have  a  stomach  habitually  sick,  or  bowels  constantly  loose,  at  the 
same  time  troubled  with  constant,  colds,  and  a  dry,  short  cough. 

The  cough,  which  is  the  result  of  gastric  irritation,  is  sometimes 
succeeded  by  hemoptysis,  after  which  tubercles  are  quickly  deve- 
loped, as  in  the  remarkable  case  quoted  in  the  note  to  Case  13;  we 
there  see  the  spitting  of  blood  produced  by,  and  subsiding  with,  the 
symptoms  of  gastritis.  Sometimes  a  true  bronchitis,  with  bloody 
expectoration,  is  the  consequence;  at  others,  a  congested  state  of 
the  lung.  Stoll  has  observed  a  great  number  of  these  bernoptyses. 
the  result  of  inflammatory  irritation  of  the  stomach.  We  must  be 
at  once  aware  of  the  evil  tendency  of  such  conditions  of  the  lung, 
where  there  exists  a  predisposition  to  phthisis,  or  where  tubercles 
exist  in  the  latent  state.  Even  this  continued  irritation  in  the  lung 
would,  as  it  has  done  in  some  cases,  produce  a  disposition  to 
phthisis,  which  is  quickly  developed  from  a  repetition  of  irritations 
in  the  stomach  of  the  same  kind. 

The  symptoms  of  gastric  irritation  sometimes  continue,  in  the 
chronic  form,  for  months,  and  even  years,  before  they  become  com- 
plicated with  any  signs  which  would  lead  us  to  suspect  any  affec- 
tion of  the  chest.  I  have  notes  of  cases  continued  for  a  series  of 


155  PARKER  ON  THE  STOMACH. 

years,  in  which  chronic  disturbances  of  the  organs  of  digestion 
were  alone  observed,  with  a  short,  dry  cough.  Auscultation  has 
indicated  nothing  for  a  long  period,  and  the  progressive  emaciation 
has  been  attributed  to  some  organic  change  in  the  stomach;  in 
time,  however,  the  physical  signs  of  tubercular  disease  in  the  lung 
have  been  set  up,  and  the  patient  has  soon  sunk  from  this  fatal 
complication  of  disease.  I  have  noted  one  case  of  this  kind  for 
three,  arid  a  second  for  seven,  years. 

In  another  form,  the  disease  is  more  quickly  developed.  I 
attended  a  lady,  previously  in  the  most  perfect  health,  who  had 
been  suddenly  seized  with  pain  in  the  stomach,  vomiting  of  food, 
and  other  symptoms  characterising  an  acute  gastritis.  The  more 
acute  symptoms  were  subdued,  but  the  affection  passed  into  the 
chronic  state;  and  at  the  end  of  twelve  months  she  died,  phthisical, 
with  large  caverns  in  both  lungs. 

We  deduce  from  these  facts  two  important  considerations: — 
1.  Inflammatory  irritations  of  the  digestive  organs  are  readily, 
under  certain  circumstances,  transmitted  to  the  lungs,  where  they 
may  become  the  source  of  various  diseases,  as  cough  and  dis- 
ordered respiration,  bronchitis,  pneumonia,  hgemoptysis,  and  even 
tubercular  phthisis.  2.  Diseases  of  the  lungs  are  frequently  com- 
plicated with  an  inflamed  condition  of  the  stomach;  and  in  framing 
a  treatment  for  the  relief  of  the  former,  we  should  be  careful  to 
avoid  the  use  of  remedies  which  would  exasperate  the  latter. 


CHAPTER  XII. 

ON  THE  INFLUENCE  OP  MORBID  STATES  OP  THE  STOMACH  UPON 
THE  ORIGIN,  PROGRESS,  AND  TERMINATION  OP  DISEASE  IN 
THE  BRAIN. 

The  brain  isjiot  less  influenced  in  the  integrity  of  its  functions, 
by  disease  of  the  mucous  surfaces  of  the  stomach,  than  are  the 
liver,  lungs,  and  heart;  and  in  many  instances  the  sympathetic 
affections  of  the  former  organ  are  of  as  much,  if  not  of  more, 
importance  than  those  we  have  already  considered. 

In  many  instances  these  are  manifested,  during  life,  by  infinite 
varieties  of  condition  of  the  reasoning  and  intellectual  powers, 
from  mere  irritability  of  temper,  to  confirmed  lunacy  or  mania. 
Sometimes  stupor  is  present ;  at  others,  pain  in  the  head,  with 
excitement.  The  functions  of  the  senses  are  impaired  or  exalted, 
whilst,  in  more  aggravated  forms,  the  disease  of  the  head  progresses 
into  profound  coma,  or  terminates  in  convulsions  or  varied  partial 
paralyses,  and  changes  in  the  sensibilities  of  different  parts  of  the 
skin. 

It  is  hardly  possible  to  determine  upon  what  exact  pathologic 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  BRAIN.         157 

condition  of  the  stomach  these  varied  forms  of  irritation  in  the 
brain  depend.  Sometimes  a  mere  hyperemic  condition  is  detected 
after  death  in  the  former  organ  ;  again,  confirmed  inflammatory 
conditions  are  present,  with  various  changes  of  colour  or  consist- 
ence. As  in  the  stomach,  so  in  the  brain ;  varied  pathologic 
changes  are  detected  after  death,  upon  which  the  symptoms 
observed  during  life  are  dependent. 

These  changes,  however,  are  not  sufficient  to  account  for  all  we 
observe.  The  organic  lesions  are,  doubtless,  combined,  in  both 
organs,  with  certain  conditions  of  excitement  in  the  nervous 
system,  which  produce  many  of  the  symptoms  observed  during 
life,  but  which  anatomy  does  not  enable  us  to  appreciate  in  the 
dead  body. 

I  have,  in  a  previous  part  of  this  work,  shown  that  the  process 
of  digestion  is  accompanied  by  a  flow  of  blood  into  the  mucous 
coat  of  the  stomach,  which  places  this  organ,  during  the  continu- 
ance of  this  function,  in  a  state  of  active  congestion.  This  active 
congestion  is  the  first  form  of  inflammation;  and  hence  it  is  that 
we  find  the  process  of  digestion,  in  many  persons,  influencing  the 
condition  of  the  brain  in  the  same  way  that  active  congestion  of 
the  stomach,  or  inflammatory  affections  of  this  organ,  do  at  other 
periods. 

The  affections  of  the  head  that  accompany  the  progress  of  diges- 
tion are  most  commonly  those  of  vascular  turgescence  (cerebral 
congestion),  and  are  evidenced  by  a  great  variety  of  symptoms. 
Thus,  many  persons  become  so  drowsy  after  a  meal  that  they  are 
unable  to  keep  awake;  others  are  tormented  with  an  intense  frontal 
headach  ;  a  third  series  experience  a  total  inability  to  the  perform- 
ance of  any  intellectual  act,  and  are  completely  stupid.  If  we 
examine  the  condition  of  the  circulation  at  these  periods,  we  shall 
find  the  action  of  the  carotids  much  increased,  both  in  frequency 
and  force,  and  the  head  much  hotter  than  at  other  times.  "  There 
can  be  no  doubt,"  says  Andral,  "that,  in  those  who  are  predis- 
posed, the  process  of  digestion  favours  the  return  of  congestion  of 
the  brain  ;  to  a  slight  degree  of  these  congestions  may  be  attri- 
buted the  drowsiness  exhibited  by  some  persons  after  meals.  With 
respect  to  diseases  of  the  stomach,  they  possess,  in  certain  cases,  a 
manifest  influence  on  the  development  of  cerebral  congestions. 
Thus,  at  all  ages,  and  particularly  in  infancy,  acute  gastro-intes- 
tinal  affections  may  be  accompanied  by  symptoms  announcing  the 
presence  of  an  undue  quantity  of  blood  in  the  brain.  The  same 
happens,  though  less  frequently,  in  chronic  cases."1 

I  shall  give  some  examples  of  the  milder,  as  well  as  of  the  more 
severe  forms  of  cerebral  affections,  consequent  upon  gastric  dis- 
turbance. 

CASE  1. — A  gentleman,  aged  thirty-two,  was  suddenly  seized 
with  nausea  and  vomiting  of  food,  which  had  continued  for  some 

1  Clinique  Medicale,  by  Spillan,  p.  St. 


153  PARKER  ON  THE  STOMACH. 

days.  He  had  at  the  same  time  great  heat  and  tenderness  in  the 
epigastrium ;  he  was  giddy,  the  vision  was  cloudy  and  indistinct, 
and  he  had  a  constant  ringing  in  the  ears.  All  the  symptoms, 
both  those  connected  with  the  head  and  those  connected  with  the 
stomach,  disappeared  from  two  applications  of  leeches  over  the 
epigastric  region. 

This  is  an  example  of  a  slight  cerebral  congestion,  succeeding 
to  a  sub-acute  affection  of  the  stomach,  of  an  inflammatory  kind. 
In  this  instance,  we  observe  the  conditions  of  the  brain  to  be 
relieved  by  removing  the  gastric  irritation  which  produced  it.  In 
many  instances,  particularly  if  any  disease  have  previously  existed 
in  the  brain,  this  apparently  trivial  derangement  of  the  stomach 
might  have  produced  a  fatal  termination  in  the  brain,  as  I  shall 
show  by  some  of  the  following  cases. 

CASE  2. — A  gentleman,  of  middle  age,  consulted  me  for  what 
appeared  to  be  an  attack  of  sub-acute  gastritis,  or  active  hyperemia. 
He  had  daily  vomiting  of  food,  some  fever,  with  great  heat  and 
tenderness  in  the  epigastric  region.  For  some  time  before  the 
occurrence  of  the  symptoms  in  an  acute  form,  he  had  been  trou- 
bled with  flatulence,  and  great  distension  of  the  stomach  after  eat- 
ing, accompanied  by  palpitations,  throbbing  of  the  carotids,  stupor, 
and  a  total  inability  to  exercise  any  mental  or  intellectual  process. 
As  the  symptoms  connected  with  the  stomach  became  more  acute, 
the  faculty  of  memory  was  totally  lost ;  yet,  during  a  state  of 
health,  this  gentleman  was  remarkable  for  the  strength  and  clear- 
ness of  his  intellect.  No  remedies  afforded  any  marked  relief 
except  the  application  of  leeches  to  the  epigastrium;  the  mind 
became  clearer,  and  the  stupor  abated  as  the  blood  flowed  from 
the  region  of  the  stomach. 

This  case,  as  well  as  the  last,  exhibits  a  form  of  vascular  fulness 
in  the  brain,  removed  by  curing  the  inflammatory  irritation  of  the 
stomach  which  produced  it.  In  many  instances,  however,  the  state 
of  the  brain  will  become  the  special  object  of  our  attention,  since 
the  symptoms  connected  with  it,  although  called  forth  by  the 
stomach  affection,  are  more  alarming  than  the  primitive  disease  to 
which  their  origin  is  due. 

We  have  seen  the  influence  of  the  process  of  digestion  upon  the 
brain,  and  those  states  of  active  congestion,  at  other  periods,  which 
resemble  it.  In  persons  who  consume  large  quantities  of  animal 
food,  and  malt,  vinous,  or  spirituous  liquors,  the  state  of  active  con- 
gestion, or  hyperemia  of  the  stomach,  becomes  constant ;  this,  how- 
ever, may  occur  from  other  causes,  and  from  none  more  frequently 
than  from  strong  mental  impressions.  These,  first  received  by  the 
brain,  and  then  transmitted  to  the  nervous  centres  of  the  epigas- 
trium, first  exalt  the  sensibility,  arid  then,  by  the  exercise  of  a 
natural  law,  determine  to  the  stomach  an  increased  quantity  of 
blood.  Here  is  now  produced  a  permanent  centre  of  irritation, 
which,  as  long  as  it  continues,  reacts  upon  the  brain,  and  disposes 
that  organ  likewise  to  irritation. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  BRAIN.          159 

Let  ns  examine  the  influence  of  both  these  classes  of  causes 
existing  in  the  stomach,  and  sympathetically  affecting  the  brain. 

I  have  shown  the  influence  of  the  former,  that  is,  of  active  con- 
gestion, or  hyperemia  of  the  stomach,  the  result  of  the  stimulus  of 
food,  upon  the  brain,  in  the  two  cases  detailed  at  the  commence- 
ment of  the  chapter.  The  second  class  now  demands  our  attention. 

CASE  3. — Influence  of  a  diseased  condition  of  the  stomach,  the  result  of 
moral  impression,  upon  the  brain. 

A  lady,  aged  25,  suffered  from  a  series  of  domestic  afflictions  for 
some  time,  having  lost  one  or  two  relatives,  to  whom  she  was 
tenderly  attached,  from  phthisis.  Her  health  now  began  to  decline, 
she  had  some  hysteric  seizures,  to  these  succeeded  nausea,  vomit- 
ing, a  disordered  condition  of  the  bowels,  accompanied  by  wander- 
ing pains,  and  an  occasional  diarrhoea ;  settled  uneasiness  in  the 
epigastrium  and  the  two  hypochondria,  with  heat,  tenderness,  and 
continual  beatings.  After  the  continuance  of  these  symptoms  for 
some  time,  she  became  affected  with  weight,  pain,  and  throbbing 
in  the  head,  fits  of  mental  irritation,  flushings  of  the  face  ;  suddenly 
she  lost  the  use  of  the  right  side.  These  symptoms  were  continued 
in  a  variety  of  forms,  through  a  series  of  five  or  six  years.  She 
was  placed  under  my  care,  and  at  that  period  presented  the  follow- 
ing state.  The  hemiphlegia  had  nearly  disappeared,  she  could 
walk  well,  but  the  pain  and  throbbing  in  the  head,  the  thirst,  flush- 
ing of  the  face  and  occasional  numbness  of  the  limbs,  made  her 
fearful  of  a  return.  The  head  was  continually  hot,  the  seat  of 
severe  pain  on  the  vertex,  with  occasionally  violent  and  sudden 
darting  pains  through  it,  which  made  the  patient  scream  out ;  the 
carotids  and  temporal  arteries  throbbed  violently,  and  the  pulsations 
were  seldom  less  than  a  hundred. 

On  examining  the  epigastric  region,  the  first  thing  that  attracted 
attention  was  a  violent  pulsation ;  of  this  beating  she  continually 
complained,  as  the  source  of  her  chief  uneasiness.  This  part  was 
full,  hot,  exceedingly  tender  on  pressure,  and  the  seat  of  internal 
pains  shooting  into  the  hypochondria,  where  she  had  also  fixed 
uneasiness. 

The  stomach  and  intestines  were  become  so  morbidly  sensible 
to  impression,  that  every  thing  she  took  produced  pain,  sickness, 
and  very  frequently  vomitings,  there  was  constantly  an  intensely 
acid  taste  in  the  mouth.  The  bowels  were  scantily  evacuated  daily, 
but  the  stools  were  dark,  and  very  offensive,  and  the  patient  enter- 
tained so  great  a  dread  of  aperient  medicines,  that,  for  the  first  week 
she  remained  under  my  care,  I  was  afraid  to  administer  them.  As 
there  appeared  no  disposition  to  amendment,  and  as  each  meal  was 
followed  by  an  aggravation  of  the  symptoms  both  in  the  head  and 
stomach,  I  determined  to  give  a  mild  cathartic.  Four  leeches  were 
placed  over  the  region  of  the  stomach,  and  five  grains  of  the  hyd. 
c.  creta,  with  five  of  rhubarb,  were  given  in  a  pill  at  bed-time. 


160  PARKER  ON  THE  STOMACH. 

The  medicines  produced  severe  griping,  and  were  followed  by 
seven  or  eight  evacuations,  as  black  as  pitch,  and  much  resembling 
it.  The  succeeding  evening,  they  were  again  given,  discharges  of 
a  better  character  were  obtained,  and  much  less  pain  was  produced 
by  their  operation.  The  remedies  were  repeated  every  night  for  a 
week,  whilst  the  patient  adhered  to  a  mild,  unstimulating  diet  of 
farinaceous  food.  At  the  end  of  this  period  she  had  no  nausea, 
sickness,  or  pains  in  the  stomach  or  bowels,  the  epigastric  pulsation 
had  disappeared  with  the  tenderness  and  heat ;  the  mind  was  calm, 
the  throbbings  and  pain  in  the  head  were  gone,  it  was  become  cool, 
and  the  arterial  pulsations  did  not  exceed  seventy.  The  patient 
was  in  fact  well. 

Remarks. — This  case  may  serve  as  a  type  of  a  certain  class  of 
diseases  in  which  we  observe  the  mutual  reaction  of  the  brain  and 
stomach  upon  each  other,  and  the  patient  suffering  from  a  class  of 
symptoms  which  are  dependent  upon  irritation  in  both  organs. 

We  observe  the  disease  of  this  lady  to  have  commenced  in 
mental  disturbance,  to  this  succeeded  attacks  of  hysteria,  which, 
during  the  paroxysms,  were  treated  by  the  free  exhibition  of  stimuli 
of  various  kinds,  aether,  brandy,  various  antispasmodics,  and  in  the 
interval  a  generous  diet  was  followed  to  give  the  patient  strength; 
we  observe,  in  the  first  instance,  that  the  brain,  excited  by  the 
mental  distress  of  the  patient,  produces  by  sympathy  a  correspond- 
ing degree  of  exalted  sensibility  in  the  nervous  centres  of  the 
epigastrium,  and  in  the  stomach.1  The  free  exhibition  of  stimu- 
lating medicines,  and  a  rich  diet,  in  such  a  state,  tend  to  change 
what  was  at  first  a  mere  exalted  condition  of  the  sensibility  into  an 
active  congestion  of  blood.  At  this  period  we  find  nausea,  vomit- 
ing, pains  after  food,  fulness  and  heat  in  the  epigastrium,  tender- 
ness on  pressure  over  the  region  of  the  stomach  and  liver,  and 
other  symptoms,  indicating  increased  determination  of  blood  to  the 
organs  concerned  in  the  function  of  digestion.  This,  kept  up  by 
rich  diet  and  stimulants,  now  reacts  upon  the  brain,  and  in  conjunc- 
tion with  mental  emotion,  produces  an  active  congestion  in  this 
organ,  under  the  influence  of  which  we  have  pain,  weight,  and 
fulness  of  the  head,  ringing  in  the  ears,  dim  vision,  &c.  which 
terminates  in  the  loss  of  power  over  the  right  side, — the  patient 
becomes  hemiplegic.  From  the  irritation  existing  in  the  stomach, 

1  Bichat  (JRecherchessurlavie  et  la  mort)  has  placed  the  seat  of  the  pas- 
sions in  the  organic  life,  i.  e.  in  the  nervous  system  supplying  the  stomach 
and  its  dependencies.  Georget,  (Physiologie  du  Systeme  Nerveux.  Mala- 
dies Nerveuses,}  on  the  contrary,  has  seated  them  in  the  brain.  It  is  plain, 
however,  that  the  mental  emotions  here  alluded  to  are  the  result  of  impres- 
sions fiist  made  upon  the  brain,  and  thence  immediately  transmitted  to  the 
nervous  system  supplying  the  stomach  and  abdominal  viscera.  Thus  we 
find  that  impressions  received  first  by  the  brain,  become  permanently  seated 
in  the  stomach,  the  condition  of  which  is  every  hour  modifying  that  of  the 
brain: — La  correspondance  entre  la  membrane  muqueuse  de  1'estpmac  et  le 
cerveau  est  telle  que  les  modifications  de  cette  membrane  paraissent  etre 
celle  du  cerveau  lui  me'me. — Broussais,  Commentaires,  $c.  t.  i.,  p.  152. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  BRAIN.          161 

the  bowels  become  costive,  and  their  secretions  scanty  and  impaired. 
In  this  state  the  patient  continues,  with  some  variation,  for  nearly 
six  years,  presenting,  at  the  end  of  this  period  a  permanent  condi- 
tion of  irritation  in  both  the  brain  and  the  stomach,  the  former,  as 
the  results  of  the  treatment  prove,  being  now  dependent  almost 
altogether  upon  the  condition  of  the  latter.  An  unstimulating  diet, 
mild  aperients,  and  the  application  of  a  few  leeches  to  the  epigas- 
trium, speedily  relieve  the  patient,  and  we  find  a  disease,  which 
had  been  kept  up  by  gastric  irritation  for  years,  give  way  immedi- 
ately that  irritation  is  removed.  It  is  in  this  manner  that  the 
stomach  becomes  the  centre  or  receiver  of  irritations  from  other 
organs,  and  by  its  own  irritations,  thus  produced,  keeps  up  disease 
in  other  parts,  when  the  causes  producing  the  first  affection  have 
long  ceased  to  act,  A  permanent  state  of  active  congestion  of  the 
mucous  membrane  of  the  stomach  tends  to  keep  up  a  permanent 
and  an  undue  fulness  of  blood  in  the  vessels  of  the  brain. 

We  may  here  enquire,  whether  this  permanent  state  of  cerebral 
congestion  in  cases  of  hyperemia  of  the  stomach  or  of  gastritis,  is 
kept  up  through  the  medium  of  increased  force  and  frequency  in 
the  actions  of  the  heart,  or  whether  it  is  dependent  on  a  direct 
transmission  of  irritation  from  one  organ  to  the  other.  It  may 
occur  in  both  ways.  There  are  certain  forms  of  disease,  com- 
mencing in  hyperernia,  or  inflammatory  conditions  of  the  stomach, 
in  which  the  brain  is  thrown  into  a  state  of  congestion  under  the 
influence  of  the  heart,  acting  with  increased  force,  and  driving  the 
blood  to  the  brain  with  an  impetus  which  is  inconsistent  with  the 
integrity  of  the  structure  and  functions  of  the  latter  organ.  In 
these  instances  the  heart  may  be  perfectly  healthy,  acting  with  in- 
creased force  under  the  irritation  kept  up  in  it  by  confirmed  affec- 
tions of  the  stomach ;  or,  on  the  other  hand,  it  may  be  itself 
diseased,  its  walls  thickened,  and  the  unusual  force  with  which  it 
would  thus  act  upon  the  brain,  may  be  still  farther  increased  by 
gastric  irritation. 

CASE  4.  A  gentleman,  aged  fifty-three,  consulted  me  in  1836, 
for  unpleasant  symptoms  connected  with  his  stomach,  stating  him- 
self to  have  been  subject  to  indigestion  for  twenty  years.  He  had 
pain,  weicrht,  and  uneasiness  in  the  region  of  the  stomach  after 
eating,  with  acid  eructations ;  the  stools  dark  coloured,  and  scanty; 
the  epigastric  region  and  the  right  hypochondrium  full,  hot,  and 
tender  on  manual  examination. 

After  eating,  he  was  subject  to  considerable  stupor,  with  pain, 
throbbing,  arid  weight  over  the  back  part  of  his  head  ;  at  these 
periods  he  was  totally  unable  to  attend  to  business  from  the  stupor 
that  came  over  him.  He  was  also  tormented  occasionally  with  an 
almost  uncontrollable  venereal  appetite  when  the  head  was  thus 
affertfid.  On  examining  the  heart,  I  found  the  impulse  unusually 
strong  and  diffused  over  a  great  extent  of  surface,  a  strong  "bruit 
de  soufflHt"  was  also  detected. 

This  patient  was  placed  upon  a  mild  farinaceous  diet;  the  food 
12 — c  park  11 


162  PARKER    ON  THE  STOMACH. 

was  given  in  small  quantities  at  short  intervals,  so  as  never  to  dis- 
tend the  stomach  or  interfere  with  the  action  of  the  heart;  eight 
leeches  were  placed  over  the  epigastrium,  and  combinations  of  the 
pil.  hyd.  with  rhubarb,  followed  by  a  solution  of  the  sulphate  and 
carbonate  of  magnesia  in  mint  water,  were  exhibited.  By  this 
treatment  the  stomach  soon  became  tolerably  comfortable;  the  un- 
pleasant symptoms  connected  with  the  head  were  materially  lessen- 
ed, and  altogether  disappeared  from  cupping  the  back  of  the  neck. 
The  state  of  the  heart  remained  the  same  ;  I  merely  remarked  that 
its  impulse  was  less. 

Remarks. — In  this  case  we  must  note  the  state  of  the  stomach, 
that  of  the  brain,  and  that  of  the  heart.  There  can  be  no  question 
but  that  the  disordered  state  of  the  former  organ  was  dependent  on, 
or  connected  with,  a  degree  of  permanent  fulness  of  blood  in  it.  In 
the  brain  we  note,  also,  the  symptoms  of  a  permanent  congestion, 
verging  almost  to  the  apoplectic  condition  after  eating.  In  fact, 
the  face  used  to  assume  a  purple  cast  after  meals.  The  hyper- 
trophy of  the  heart  must  have  influenced  the  congestion  of  the 
brain  materially  in  this  case ;  and,  independent  of  the  direct  rela- 
tion between  the  brain  and  the  stomach,  the  heart,  in  such  instances 
as  the  present,  powerfully  modifies  the  state  of  the  brain.  The 
stomach,  however,  is  the  organ  through  which  the  chief  influences 
are  impressed  upon  both  heart  and  brain.  Thus  the  process  of 
digesting  a  full  meal,  in  a  stomach  already  morbid,  first  irritates 
the  heart  by  increasing  the  force  and  frequency  of  its  pulsations, 
and  then  modifies  the  circulation  in  the  brain  through  the  medium 
of  the  heart.  The  stomach,  also,  acts  directly  upon  the  brain 
through  the  media  of  the  sympathies  which  connect  them,  inde- 
pendently of  the  influence  which  is  exercised  over  the  latter  organ 
through  the  medium  of  the  heart. 

I  have  shown,  in  the  preceding  cases,  the  influence  of  the  stomach 
upon  the  brain  in  certain  circumstances.  These  circumstances 
were  a  healthy  condition  of  the  brain,  and  a  diseased  one  on  the 
part  of  the  stomach.  I  shall  now  illustrate  the  influence  of  the 
stomach  upon  the  brain,  where  disease  exists  in  both  organs. 
It  must  be  borne  in  mind,  during  the  whole  of  these  remarks,  that 
the  process  of  digestion  is,  as  I  have  before  frequently  stated,  one  of 
hyperemia,  or  of  active  congestion  of  the  mucous  membrane  of  the 
stomach  ;  this  hyperemia  varying  in  degree  and  extent,  in  direct 
relation  to  the  quantity  of  food  taken,  and  to  its  stimulating  proper- 
ties. This  active  congestion  is  repeated  or  reproduced  in  the  brain 
as  long  as  it  continues  in  the  stomach,  in  two  ways ;  by  the  direct 
action  of  one  organ  upon  the  other,  or  through  the  intervention  of 
the  heart.  We  need  only  analyse  the  condition  of  the  organs,  after 
a  full  meal,  to  be  convinced  of  this.  The  arterial  excitement,  the 
stupor  or  drowsiness,  the  variations  in  the  condition  of  the  intel- 
lectual powers  after  a  full  meal,  are  dependent  upon  this  cause. 

As  I  have  before  said,  this  state  of  the  stomach  produces,  during 
its  continuance,  a  corresponding  congestion  in  the  brain,  which 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  BRAIN.         163 

subsides  when  its  exciting  cause  no  longer  ceases  to  act,  in  other 
words  when  digestion  is  completed.  This  daily  repetition  of  eva- 
nescent congestion  in  a  healthy  brain,  perhaps  does  no  more  mischief 
than  predisposing  to  permanent  states  of  affection  of  the  head,  on 
the  occurrence  of  slight  exciting  causes  ;  but,  where  disease  exists 
already  in  the  brain,  the  return  of  every  meal  threatens  a  fatal  form 
of  congestion. 

CASI-:  5. — August  14,  1835.  A  man  aged  forty,  of  intemperate 
habits,  had  some  years  previous  to  the  present  date,  a  fall  upon  the 
head  during  a  state  of  intoxication,  and  a  year  since,  a  second. 
These  falls  were  succeeded  by  occasional  headachs.  Four  days 
prior  to  the  present  date,  he  was  seized  with  vomiting,  diarrhoea, 
and  severe  pain  in  the  region  of  the  stomach  after  eating  some  in- 
digestible food.  During^  the  continuance  of  these  symptoms  he 
complained  of  giddiness.  On  the  third  day  from  the  commence- 
ment of  sickness  and  diarrhosa,  he  ate  freely  of  cucumber,  and  a 
mixture  of  other  aliments.  After  the  meal  he  felt  drowsy  and 
stupid ;  this  increased,  and,  during  the  night,  he  fell  into  a  state  of 
profound  coma.  He  remained  totally  insensible  to  impressions  of 
all  kinds  :  one  thing  only  appeared  to  affect  him,  this  was  pressure 
upon  the  epigastric  region.  When  it  was  done,  he  experienced 
slight  convulsive  motions  of  the  limbs,  which  could  be  brought  on 
as  often  as  the  hand  was  laid  with  moderate  force  upon  the  stomach. 
He  was  bled  from  the  arm;  twenty-five  leeches  were  applied  behind 
the  ears,  and  upon  the  temples;  and  some  croton  oil  was  given. 
The  remedies  afforded  no  relief;  he  died  about  thirty-six  hours 
from  the  commencement  of  the  stupor. 

Post-mortem  examination  eight  hours  after  death. — Great 
thickening  of  the  dura  mater  covering  the  posterior  third  of  the 
cerebral  hemispheres.  The  membranes  were  here  all  so  completely 
amalgamated  that  they  could  not  be  separated  from  the  substance 
of  the  brain  without  bringing  portions  of  it  away  with  them.  The 
central  white  portions  of  the  brain  studded  every  where  with  red 
points,  from  which  oozed  great  quantities  of  thick  black  blood.  The 
orifices  of  some  of  these  vessels  would  easily  have  admitted  the 
point  of  a  small  crow-quill.  The  lateral  ventricles  contained  about 
an  ounce  and  a  half  of  turbid  serum.  On  the  inferior  surface  of 
the  left  middle  lobe  was  found  a  softened  portion  of  brain  about 
the  size  of  a  walnut,  of  the  consistence  and  appearance  of  curd, 
which  fell  out  on  raising  the  encephalic  mass.  The  other  parts  of 
the  brain  were  remarkably  firm  and  healthy. 

The  mucous  membrane  of  the  stomach  was  vividly  injected, 
covered  in  its  pyloric  half,  more  particularly,  with  intensely  red 
dotting  and  arborescence. 

Remarks. —  We  have  seen  in  the  preceding  cases,  that  a  tempo- 
rary state  of  congestion  is  induced  in  the  brain  after  a  full  meal, 
during  the  whole  time  the  digestive  process  continues.  In  these 
instances  the  fulness  of  blood  in  the  brain  is  merely  a  repetition  in 
in  that  organ  of  what  exists  in  the  stomach.  The  affection  of  the 


164  PARKER  ON  THE  STOMACH. 

head,  whilst  the  brain  and  its  membranes  are  healthy,  strictly  de- 
pending upon  the  state  of  the  stomach,  soon  reassumes  the  natural 
condition  when  digestion  is  finished,  or  when  the  fulness  of  blood  in 
the  mucous  coat  of  the  stomach  has  disappeared.  Not  so,  however, 
is  the  state  of  things  when  disease  exists  in  the  brain  or  its  mem- 
branes, independent  of  any  influence  impressed  upon  them  by 
gastric  irritation.  These  old  standing  diseases  of  the  brain,  as  in 
the  present  case,  are,  as  Andral  has  well  observed,  so  many  thorns, 
which  are  continually  irritating  the  brain  and  deter  mining  conges- 
tions, variable  in  degree  and  intensity.  We  observe,  however,  in 
the  present  instance,  which  may  be  taken  as  the  type  of  a  class, 
that  the  cerebral  congestion,  determined  by  the  disease  of  the  brain, 
never  affected  the  patient,  as  long  as  the  stomach  was  healthy, 
more  than  by  occasioning  severe  headachs.  Under  the  influence 
of  irritation  existing  in  the  stomach,  we  see  the  congestion  in  the 
brain  augmented  to  a  fatal  degree,  and  the  patient  die  comatose 
during  a  state  of  cerebral  congestion.  The  subject  of  this  case 
never  complained  of  giddiness  even,  till  the  vomiting  and  diarrhoea 
came  on ;  he  then  suffered  from  giddiness  and  stupor,  which  in- 
creased to  profound  coma  as  the  gastric  irritation  progressed,  and 
became  aggravated. 

This  case  shows  that  a  full  meal,  which  determines,  whilst  the 
brain  is  in  a  healthy  state,  merely  so  much  blood  to  it,  as  inclines 
to  a  degree  of  drowsiness  and  stupor,  may,  when  disease  exists  in 
the  brain,  cause  a  congestion  of  a  character  sufficiently  intense  to 
occasion  death. 

Richond1  has  detailed  three  cases  of  this  form  of  gastric  apoplexy, 
if  I  may  so  express  myself;  cases  in  which  the  patients  after  having 
suffered  from  chronic  affections  of  the  stomach  and  liver  for  a 
longer  or  shorter  period,  suddenly  fell  victims  to  apoplexy,  when 
the  disease  of  the  stomach  assumed  a  more  acute  form.  I  have,  in 
the  preceding  cases,  sufficiently  explained  the  manner  in  which 
attacks  of  apoplexy  or  fatal  cerebral  congestion  take  place  after  pro- 
longed irritation  of  the  stomach  of  the  inflammatory  kind. 

I  must  again  call  the  reader's  attention  to  the  fact,  that  the  pro- 
cess of  digestion  is  one  which  determines  into  the  coats  of  the 
stomach  a  flow  of  blood  proportionate  to  the  quantity  of  aliment 
taken  and  to  its  quality ;  that  which  offers  most  resistance  to  the 
action  of  the  gastric  fluids  promotes  the  greatest  flow  of  blood,  and 
causes  the  greatest  irritation.  Thus  it  will  be  perceived  that  the 
process  of  digestion  of  large  quantities  of  food  differs  but  little  from 
that  primitive  morbid  state  of  the  stomach  I  have  described  in  this 
work  under  the  title  Hyperemia  (excess  of  blood,  not  combined 
with  the  tissue  of  the  organ  in  which  it  takes  place,  and  conse- 
quently not  strictly  of  an  inflammatory  character.) 

1  De  1'Influence  de  PEstomac  sur  la  Production  de  1'Apoplexie. — Paris, 
1824.  Similar  forms  of  apoplexy  or  fatal  cerebral  congestion  have  also  been 
observed  by  Schroeter,  De  apoplexizt  ex  prsecordiis  vitiis,  &c.  and  Koch,  De 
apoplexia  bilios&. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  BRAIN.          165 

CASE  6. — A  little  boy,  aged  ten,  had  been  indisposed  for  some 
weeks,  he  suffered  from  occasional  fits  of  stupor,  and  once  in  every 
two  or  three  days  had  a  slight  convulsion.  The  convulsions  in- 
creased and  at  length  occurred  daily  after  dinner.  At  this  meal  he 
ate  voraciously,  and  consumed  large  quantities  of  animal  food;  fell 
asleep  immediately  he  had  dined,  and  awoke  convulsed.  He  was 
directed  to  take  daily  a  grain  and  a  half  of  calomel,  with  four  of 
rhubarb,  and  his  food  was  given  to  him  in  very  small  quantities  at 
stated  periods.  He  had  no  return  of  his  convulsions  after  this  plan 
of  treatment  was  established. 

Remarks. — This  case,  not  of  unfrequent  occurrence,  is  adduced 
as  an  example  of  hyperemia  of  the  stomach,  consequent  upon  the 
digestion  of  large  quantities  of  stimulating  food,  producing  a  similar 
condition  of  the  brain  under  the  influence  of  which  convulsions  are 
excited.  The  hot  and  sensible  stomach,  the  stupid  and  heavy  head 
at  once  prove  this  to  be  the  pathologic  state  of  both  organs.  Here 
we  observe  no  disease  except  what  the  state  of  the  stomach  during 
digestion  produces.  By  reducing  the  quantity  of  food,  so  as  to 
lessen  the  degree  of  excitement  in  the  stomach  during  digestion, 
all  the  evils  give  way.  If,  on  the  contrary,  the  same  manner  of 
living  had  been  continued,  it  is  highly  probable  that  the  complaint, 
already  excited  in  the  head,  might  have  terminated  in  serous  effu- 
sion, or  a  fatal  form  of  congestion  of  blood. 

There  are  other  forms  of  cerebral  disease  consequent  upon 
gastric  irritation,  which  do  not  consist  purely  in  fulness  of  blood. 
In  the  forms  of  disease  I  have  passed  in  review,  the  morbid  actions 
observed  are  confined  chiefly,  if  not  altogether,  to  the  vascular 
system.  In  the  present  series  of  cases,  irritation  is  seated  princi- 
pally in  the  nervous  system  of  the  parts  affected,  and  the  forms  of 
vascular  excitement  which  accompany  them  are  secondary,  though 
demanding  great  attention,  since,  in  the  brain,  such  affections 
much  more  commonly  terminate  in  fatal  effusion,  than  in  the 
instances  already  adduced. 

The  irritations  of  the  stomach,  which  produce  the  affections  of 
the  brain  I  am  about  to  notice,  exhibit  symptoms  of  a  character 
different  from  those  just  mentioned  ;  whilst  the  sympathetic  affec- 
tions observed  in  the  brain  are  likewise  indicated  by  distinct  symp- 
toms. The  following  cases  will  afford  examples  of  the  nature, 
progress,  and  terminations  of  such  affections,  and  the  mode  of 
treatment  best  calculated  to  afford  relief. 

CASE  7. — An  elderly  lady  consulted  me  in  the  spring  of  last 
year,  for  painful  sensations  connected  with  the  digestion  of  her  food, 
which  had  harassed  her  for  some  time,  and  which  lately  had  been 
attended  by  symptoms  which  had  occasioned  her  some  alarm. 
After  eating  a  moderate  quantity  of  the  ordinary  kinds  of  food,  she 
was  tormented  by  a  pain  in  the  stomach,  which  sometimes  became 
extremely  violent :  the  pain  was  accompanied  by  great  swelling  of 
the  stomach,  nausea,  and  occasional  vomiting.  The  bowels  were 
confined,  although  a  mild  aperient  acted  freely  upon  them;  the 


166 


PARKER  ON  THE  STOMACH. 


tongue  dry,  smooth,  and  red  ;  (he  epigastric  region  hot,  and  sensible 
to  pressure.  The  pulse  was  remarkably  slow,  full,  and  unsteady, 
occasionally  intermitting.  After  the  pain,  nausea,  .and  distension  of 
the  stomach  had  continued  for  a  few  days,  the  patient  began  to 
complain  of  giddiness,  ringing  in  the  ears,  and  pain  in  the  head,  with 
great  stupor  and  imperfect  or  distorted  vision.  The  state  of  the  head 
bore  a  strict  relation  to  the  affection  of  the  stomach,  and  was  miti- 
gated or  aggravated  with  it.  If  the  pain  and  uneasy  sensations  in 
the  stomach  were  worse,  the  stupor  aud  indistinct  vision  were  worse 
also;  whatever  increased  the  affection  of  the  stomach  added  to  the 
complaint  in  the  head.  Local  depletions  from  the  epigastrium, 
with  anodyne  fomentations  over  that  region,  for  an  hour  or  two  in 
the  course  of  every  day,  afforded  great  relief.  Still,  stupor  and  pain 
in  the  head,  with  affections  of  the  sight  and  hearing,  continued,  and 
demanded  special  attention.  These  were  materially  benefited  by 
blisters. 

The  effects  of  aperient  medicines  in  this  case  demand  particular 
attention,  for  although  the  head  and  stomach  were  both  made 
worse  by  constipation,  active  aperients  did  more  harm  than  the 
confined  bowels.  The  state  of  the  stomach,  and  that  of  the  head, 
were  never  relieved  by  active  aperients,  such  as  combinations  of 
aloes  and  rhubarb,  or  solutions  of  the  neutral  salts  in  bitter  infu- 
sions. They  ahoays  added  to  the  irritation  already  existing. 
I  recommended  four  grains  of  rhubarb  to  be  exhibited  three  times 
a  day,  with  an  eighth  of  a  grain  of  the  muriate  of  morphia.  This 
lady  likewise  took  the  hydrocyanic  acid  in  the  mistura  cretse  with 
great  relief.  The  rhubarb  generally  kept  the  bowels  sufficiently 
open  :  its  operation  was  occasionally  assisted  by  an  injection  of 
warm  salt  and  water. 

Remarks. — We  have  to  remark,  in  this  case,  the  nature  of  the 
disease,  and  the  effects  of  remedies.  The  affection  of  the  sensibility 
observed  in  the  stomach,  evidenced  by  pain,  distension,  nausea, 
vomiting,  &c.,  was  unquestionably  combined  with  inflammatory 
action,  and  was  one  of  those  forms  of  disease  described  in  the  earlier 
parts  of  this  work,  in  which  lesions  of  the  sensibility  of  the  stomach 
are  combined  with  a  certain  form  and  degree  of  inflammation.  We 
observe  a  repetition  of  the  disease  in  the  stomach  to  arise  sympa- 
thetically in  the  brain  ;  and  here  the  same  pathologic  state  is  recog- 
nised. At  the  time  that  we  notice  an  excited  state  of  the  circulation 
in  the  brain,  marked  by  the  heat  of  the  head,  and  increased  force 
of  the  pulsation  of  the  carotid  arteries,  we  observe  a  degree  of  irri- 
tation which  is  proper  to  this  organ  as  a  mass  of  nervous  matter  ; 
this  irritation,  being  marked  by  the  giddiness,  ringing  in  the  ears, 
and  the  imperfect  and  distorted  vision.  That  these  latter  symptoms 
are  not  altogether  dependent  upon  vascular  excitement  is  evident, 
since  they  yield  more  readily  to  blisters  than  to  the  local  abstraction 
of  blood.  Hence  it  is  that  these  forms  of  irritation  in  the  brain  ter- 
minate, not  in  cerebral  congestion,  not  in  undue  fulness  of  blood, 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  BRAIN.  167 

but  in  effusion  of  serum  ;  and  these  terminations  occur  when  pre- 
vious local  vascular  excitement  in  the  brain  has  not  existed,  or  has 
been  so  trivial  that  it  is  impossible  to  attribute  to  it  the  results 
which  we  witness. 

We  notice  in  this  case  a  point  of  great  importance — the  effect  of 
active  aperients  on  the  condition  of  the  stomach  and  brain.  Brous- 
sais  has  said  that,  in  gastric  or  gastro-enteric  inflammations,  aperient 
remedies  are  decidedly  injurious,  adding  to  the  irritation  and  tend- 
ing to  the  production  of  fatal  organic  changes  in  the  mucous  mem- 
brane of  the  stomach.  Others  have  treated  these  opinions  as 
chimerical,  and  have  continued  to  harass  a  membrane  already  irri- 
tated by  a  succession  of  remedies  calculated  to  do,  in  such  states, 
incalculable  mischief.  From  my  own  experience,  drawn  from  close 
attention  to  this  class  of  diseases  for  many  years,  I  am  convinced 
that,  although  in  many  forms  of  gastric  disease  aperient  remedies, 
of  a  certain  kind,  are  borne  well  and  are  productive  of  material 
benefit,  still  there  is  another  class  of  cases  in  which  they  are  as 
positively  hurtful,  and  this  class  is  well  exemplified  by  the  case  just 
related.  Not  only  are  aperients  injurious  to  the  particular  stomach 
irritation  in  question,  but  they  are  also  prejudicial  to  the  sympathetic 
affections  which  it  excites,  since  the  irritation  in  the  stomach  which 
produced  the  sympathetic  disease,  and  upon  which  it  depends,  is 
aggravated  by  the  remedies  employed.  I  believe  that  a  constant 
repetition  of  irritating  aperients,  in  a  case  like  the  present,  would,  in 
all  probability,  have  terminated  in  serous  apoplexy.1  The  mode  in 
which  constipation  may  be  most  effectually  removed,  in  cases  of 
great  irritability  of  the  stomach  where  constipation  appears  to  add 
to  the  complaint,  is  exemplified,  among  others  in  the  treatment  of 
the  last  case. 

The  forms  of  gastric  irritation  I  have  just  described,  occasionally 
terminate  in  fatal  forms  of  disease  in  the  brain,  as  the  following  case 
will  show. 

CASE  8. — In  October  1835,  a  young  lady,  aged  seven,  was 
brought  to  me,  slightly  indisposed.  The  parents  supposed  the  sto- 
mach to  be  disordered  from  some  indigestible  food  which  had  been 
eaten.  The  child  complained  of  griping  pain  in  the  belly  occa- 

oiicilly;  she  had  constant  uneasiness  and  soreness  about  the  epi- 
astrium,  with  a  red  contracted  tongue,  and  some  slight  frequency 
of  pulse.  There  was  no  complaint  whatever  of  the  head,  nor  did 
the  patient  exhibit  the  slightest  degree  of  stupor.  The  next  day 
the  pulse  was  slow,  creeping  and  occasionally  unsteady.  I  now 
looked  upon  the  case  with  suspicion,  arid  stated  my  fears  of  the 
result.  On  the  evening  of  that  day,  the  stupor  increased,  and  on 
the  following  morning  she  was  profoundly  comatose.  In  this  state 


1  "  Purging  medicines  sometimes  relieve  unpleasant  sensations  ;  but  they 
do  not  in  general  produce  even  this  effect ;  and  all  active  purges  seem  to  me 
to  increase  disorder.  It  is  natural  to  suppose  that  strong  stimuli  will  aggra- 
vate the  unhealthy  condition  of  weak  and  irritable  parts." — Abernethy,  p.  53. 


168  PARKER  ON  THE  STOMACH. 

she  lingered  for  some  days,  perfectly  insensible  to  every  thing, 
except  pressure  upon  the  epigastrium.  If  this  were  done  she 
writhed,  and  appeared  to  suffer  great  pain,  uttering  a  mournful  cry. 
some  dark  green  evacuations  were  passed  involuntarily  during  the 
continuance  of  the  coma.  She  died  on  the  fifth  day  from  its  com- 
mencement. 

Permission  could  not  be  obtained  to  examine  the  body. 

Remarks. — The  brain  and  spinal  chord,  in  children,  appear  to 
sympathise  more  readily  with  gastro-intestinal  irritation  than  in 
adults.  Hence  is  it  that  we  see  the  slightest  forms  of  gastritis,  or 
even  gastric  irritation,  speedily  produce  in  them  convulsive  motions 
by  the  rapidity  with  which  such  irritations  radiate  to  the  great 
nervous  centres.  The  case  just  adduced  is  an  example  of  this. 
Although  convulsions,  the  result  of  gastric  irritation,  are  more 
common  in  children  and  young  persons,  still  they  are  occasionally, 
under  certain  conditions  of  the  nervous  system,  observed  in  adults. 

A  middle  aged  man  was  seized,  without  any  known  cause,  with 
profuse  bilious  vomiting,  pain  in  the  epigastrium,  and  fever.  About 
twenty  hours  after  the  appearance  of  these  symptoms,  he  began  to 
feel  some  difficulty  in  depressing  the  jaw;  violent  trismus  soon  set 
in,  and  continued  for  the  two  following  days.  The  spasm  extended 
to  the  muscles  of  the  trunk,  and  the  patient  died. 

On  examining  the  body,  the  brain  and  spinal  chord  were  found 
perfectly  healthy,  as  far  as  anatomy  was  capable  of  appreciating 
their  condition.  The  stomach  throughout  its  whole  extent  was  of 
an  intensely  red  colour;  this  resulted  from  "the  injection  of  an 
immense  number  of  small  vessels."  This  inflamed  condition  could 
not  be  perceived  till  a  thick  layer  of  mucus,  which  lined  the  surface 
of  the  stomach,  was  removed.' 

One  point  in  the  history  of  this  case  is  deserving  of  particular 
attention.  Although  the  disease  was  ushered  in  by  symptoms 
exclusively  referable  to  the  stomach,  still,  after  the  sympathetic 
disease  which  the  gastric  irritation  had  called  forth  was  fully  esta- 
blished, the  vomiting  and  pain  in  the  stomach  ceased:  yet,  after 
death,  we  find  the  most  vivid  inflammation ;  although  this  affection 
of  the  stomach  had  ceased  to  be  indicated  by  the  symptoms  which 
primarily  accompanied  it,  the  disease  is  still  observed  to  remain. 
In  this,  as  in  many  other  examples  detailed  in  this  work,  we  observe 
the  symptoms  of  the  primitive  disease  of  the  stomach  to  be  masked 
by  the  more  formidable  ones  which  accompany  the  sympathetic 
affection. 

It  is  thus  that  we  find  the  symptoms  of  gastric  irritation  some 
times  exhibited  in  the  heart,  at  other  times  in  the  lungs,  and  again 
in  the  brain  or  muscular  system,  whilst  the  symptoms  directly  indi- 
cative of  a  diseased  condition  of  the  stomach  are  obscure.  These 
remarks  apply  equally  to  chronic  as  to  acute  diseases. 

The  integrity  of  the  intellectual  powers  is  unquestionably  modi- 

'Clinique  M6dicale,  Case  30,  p.  676. 


INFLUENCE  OF  ITS  MORBID  STATES  ON  THE  BRAIN.  169 

fied  by  the  condition  of  the  material  organ,  through  which  these 
symptoms  are  made  manifest:  hence  is  it  that  we  find  different 
states  of  the  mind  dependent  upon  different  conditions  of  the  san- 
guineous circulation  in  the  brain.  I  have  shown,  in  the  preceding 
cases,  the  influence  exercised  by  diseases  of  the  stomach  upon  the 
condition  of  the  circulation  in  the  brain  in  the  production  of  various 
forms  of  cerebral  congestion,  and  its  termination  in  serous  and 
sanguineous  apoplexy.  I  shall  now  bring  forward  some  examples 
to  illustrate  the  influence  which  these  modified  conditions  of  the 
circulation  in  the  brain,  the  result  of  gastric  irritation,  exercise 
upon  the  condition  of  the  intellectual  powers,  and  the  production 
of  diseases  of  the  mind. 

I  was  consulted  by  the  friends  of  a  middle-aged  lady,  in  the 
summer  of  1834,  for  symptoms  connected  with  a  disordered  con- 
dition of  the  mind,  which  they  fancied  depended  upon  her  general 
health.  The  patient  was  subject  to  extraordinary  fits  of  irritability. 
She  complained  of  uneasiness  in  the  region  of  the  stomach,  which 
was  hot,  tender,  and  the  seat  of  a  strong  pulsation,  but  had  no 
other  symptom  indicating  gastric  disease.  She  was  materially 
benefited  by  leeching  the  epigastrium,  and  by  the  exhibition  of 
warm  stomachic  aperients:  these  remedies  had  always  a  marked 
effect  upon  the  condition  of  the  mind.  I  afterwards  lost  sight  of 
the  patient,  but  learned  that  she  became  a  confirmed  maniac. 

A  poor  woman  had  been  ill  for  many  months  with  vomiting  after 
meals  and  a  sense  of  broiling  in  her  stomach,  accompanied  by  in- 
describable sensations  of  uneasiness  in  the  part,  which  did  not 
amount  to  pain,  but  produced  the  utmost  degree  of  despondency. 
Stimulating  medicines  and  a  full  diet  were  resorted  to  by  her  medical 
attendants.  She  soon  became  completely  insane,  but  ultimately 
recovered. 

A  young  man,  mentioned  by  Pinel,  swallowed  some  cigars: 
inflammation  of  the  stomach  followed,  which  terminated  in  melan- 
choly and  suicide. 

A  soldier,  whose  case  is  likewise  alluded  to  by  this  author,  swal- 
lowed a  glass  of  brandy  containing  gunpowder:  mania  succeeded, 
which  lasted  several  months. 

I  was  consulted  by  R.  V.,  some  time  since,  for  uneasy  sensations 
connected  with  his  stomach.  These  constantly  distressed  him,  but 
were  worse  after  eating.  He  had  occasional  vomiting,  distension 
of  the  stomach,  eructations,  and  slight  uneasiness  in  the  epigastric 
region.  He  received  little  benefit  from  medicine,  but  was  so  far 
relieved  by  leeches  and  a  blister  to  the  stomach,  that  he  returned 
to  his  occupation,  fancying  himself  well.  I  was  suddenly  sum- 
moned to  him  some  time  afterwards,  and  found  him  suffering  from 
great  mental  uneasiness,  accompanied  by  pain  in  the  head,  heat  in 
the  forehead  and  temples,  acute  pain  in  the  epigastrium,  which  the 
patient  could  cover  with  his  finger,  frequent  vomiting  of  sour  fluids, 
pinched  and  anxious  countenance,  cold  skin,  and  a  small,  frequent 
pulse.  He  has  never  been  quite  free  from  uneasiness  after  his 


170  PARKER  ON  THE  STOMACH. 

meals  since  my  first  attendance:  but  the  paroxysms  of  pain  now 
succeeding  a  meal  are  terrible  till  it  is  rejected  by  vomiting.  His 
nights  are  restless:  and  if  he  sleep  at  all,  he  is  tormented  by  dreams 
of  a  most  extraordinary  character,  intensely  vivid  and  distinct.  In 
the  waking  state  he  is  visited  byJiallueinations^of  all  kinds,  the 
most  common  of  which  is  that  of  a  large  bird,  which  flying  against 
his  head  with  great  force,  produces,  as  he  imagines,  his  headach. 
In  the  day,  the  desire  to  commit  suicide  is  almost  irresistible,  and 
his  wife  is  obliged  to  remove  all  dangerous  instruments  from  his 
presence. 

Small  numbers  of  leeches  applied  over  the  epigastrium,  succeeded 
by  a  blister,  using  internally  a  combination  of  rhubarb  with  the 
muriate  of  morphia,  at  the  same  time  restricting  my  patient  to  a 
mild,  unstimulating  diet,  completely  cured  his  stomach,  whilst  his 
mind  was  restored  to  its  accustomed  tranquillity  with  it.  This  is 
an  example  of  the  first  degree  of  those  forms  of  mental  excitement 
the  result  of  gastric  irritation,  which  occasionally  terminate  in 
lunacy  or  mania,  and  of  which  I  have  just  reported  some  c^ses. 
This  patient  would  most  certainly  have  destroyed  himself  had  he 
been  treated  with  stimuli,  or  suffered  to  indulge  in  a  mixed,  full 
diet,  which  created  any  irritation  in  the  stomach  during  the  process 
of  digestion. 

I  have  reported  in  the  earlier  parts  of  this  work  some  cases  of 
morbid  states  of  the  stomach  dependent  upon  large  losses  of  blood; 
these  forms  of  disease  occasionally  produce  affection  of  the  mind 
much  resembling  those  which  result  from  other  causes. 

A  lady  had  been  subject  for  some  time  to  large  losses  of  blood 
from  the  uterus.  When  I  first  saw  her,  the  chief  complaint  was 
of  the  stomach.  She  had  internal  heat  and  broiling,  uneasiness, 
sensations  of  something  at  work  within,  nausea,  vomiting,  and 
great  pain  after  eating.  The  epigastric,  region  was  hot,  and  the 
seat  of  a  strong  pulsation;  manual  examination  of  it  produced  in- 
describable feelings  of  dread  and  anxiety.  Her  mental  distress  was 
extreme,  and  the  anxiety,  restlessness,  and  irritability  verged  very 
closely  upon  a  state  of  perfect  mental  alienation.  I  recommended 
a  full  diet,  and  ordered  the  carbonate  of  iron  to  be  taken  with  myrrh 
and  rhubarb.  The  patient  speedily  recovered  from  this  plan  of 
treatment.  So  closely  do  symptoms,  depending  upon  totally  oppo- 
site states,  resemble  each  other. 

In  enquiring  into  the  influence  of  the  stomach  upon  the  brain, 
we  must  commence  with  a  notice  of  the  period  of  digestion,  since 
we  observe  the  condition  of  the  brain,  and  that  of  the  intellectual 
powers  to  be  most  materially  modified  by  this  process.  A  full 
meal  determines  in  the  brain  a  degree  of  evanescent  congestion,  or 
turgescence  which  continues  as  long  as  the  process  of  digestion 
lasts.  The  effect  of  this  state  of  the  circulation  in  the  brain  is 
variable  in  different  individuals;  in  some  it  inclines  to  stupor,  in 


INFLUENCE  OF   ITS  MORBID  STATES  ON  THE  BRAIN.  171 

others  to  loss  of  memory,  it  disposes  a  third  to  rest,  whilst  in  a 
fourth  it  produces  restlessness.1 

That  condition  of  the  stomach  which  I  have  described  as  active 
hyperemia,  in  many  instances  reacts  upon  the  brain;  and  by  pro- 
ducing a  similar  state  of  that  organ  modifies  and  changes  its  mode 
of  action.  In  case  1,  we  observe  this  condition  of  the  brain  to  be 
accompanied  by  disorder  in  the  functions  of  the  senses,  the  vision 
was  indistinct,  there  was  ringing  in  the  ears  and  giddiness.  In 
case  2,  a  similar  condition  of  the  brain  consequent  upon  the  same 
state  of  gastric  irritation,  we  have  the  intellectual  powers  affected, 
the  patient  lost  the  faculty  of  memory,  and  the  tone  of  the  mind  in 
other  respects  weakened. 

In  both  these  instances  we  observe  the  first  degree  of  that  dis- 
turbance in  the  brain  which  in  more  acute  forms  of  disease,  termi- 
nates in  coma,  apoplexy,  or  mania.  Passing  on  to  a  more  serious 
degree  of  complaint  in  the  stomach,  we  recognise  the  confirmed 
inflammatory  state,  combined  in  various  ways  with  derangements 
of  the  sensibility  of  the  stomach,  and  consequently  with  different 
conditions  of  nervous  and  vascular  excitement  in  the  brain. 

The  morbid  states  of  the  stomach  which  most  materially  influence 
the  condition  of  the  brain  are  three: 

1.  Inflammatory  states. 

2.  Diseases  of  its  sensibility. 

3.  Disordered  states  of  its  secretions. 

In  practice,  however,  none  of  the  states  will  be  found  single  and 
uncombined.  We  find  the  inflammatory  state  constantly  existing 
with  the  disease  of  sensibility,  and  the  disordered  state  of  the  secre- 
tions sometimes  depending  upon  inflammation,  and  in  others,  due 
to  different  forms  of  nervous  disease  in  the  stomach. 

The  affections  of  the  brain  which  succeed  to  these  forms  of  irri- 
tation in  the  stomach  are  various,  and  may  be  classed  in  the  follow- 
ing order: — 

1.  Evanescent  stupor,  or  drowsiness. 

2.  Coma. 

3.  Fatal  forms  of  cerebral  congestion. 

4.  Effusion. 

5.  Convulsions. 

6.  Variations  in  the  conditions  of  the  intellectual  powers. 

a.  Excitement,  delirium. 

b.  Melancholy,  depression. 

c.  Loss   of  one   or   more  of  the  mental  faculties,  as   me- 
mory, &c. 

7.  Alterations  in  the  functions  of  the  senses. 

The  ferain  appears  to  be  influenced  through  the  medium  of  the 
stomach,  in  most  instances,  by  the  direct  transmission  of  irritation 
from  one  organ  to  the  other.  The  relations  between  the  mucous 

1  See  the  chapter  on  the  physiological  influence  of  the  Stomach  upon  the 
Brain. 


172  PARKER  ON  THE  STOMACH. 

membrane  of  the  stomach  and  the  brain  are  so  intimate,  that  we 
find  if  the  circulation  in  the  stomach  be  accelerated,  if  this  organ 
be  in  a  state  of  hyperemia,  or  active  congestion,  the  same  state  is 
produced  in  the  brain.  Whatever  excites  the  stomach  quickens 
the  circulation  in  the  latter  organ.  These  remarks  are  well  illus- 
trated by  some  of  the  preceding  cases,  and  it  is  from  this  circum- 
stance that  we  find  persons  subject  to  stupor,  and  great  drowsiness 
after  eating,  become  suddenly  apoplectic  after  a  meal.  Richond 
has  recorded  three  cases,  and  I  have  detailed  two,  of  patients  becom- 
ing suddenly  apoplectic,  or  comatose  under  the  influence  of  gastric 
irritation,  which  had  suddenly  assumed  an  acute  form. 

We  must  remember,  as  Broussais  has  very  justly  remarked,  that 
neither  medicine  nor  food  can  influence  the  condition  of  our  organs 
except  by  modifying  the  condition  of  the  stomach.  And  he  assures 
us  that  when  we  observe  the  eyes  and  the  face  redden  from  intoxi- 
cation, it  is  because  the  mucous  membrane  of  the  stomach  has 
itself  first  suffered  from  this  state.1  It  is,  however,  when  the  sto- 
mach, previously  morbid,  is  thrown  into  a  state  of  increased  irri- 
tability by  food  greater  in  quantity  than  the  digestive  powers  can 
easily  dispose  of,  or  of  a  nature  which  is  not  easily  acted  upon  by 
the  secretion  of  the  stomach,  that  we  observe  the  forms  of  sympa- 
thetic irritation  in  the  brain  that  I  have  already  noticed. 

It  is  in  these  circumstances,  more  particularly,  that  we  observe 
the  brain  sympathising  with  the  stomach,  and  remark  those  infinite 
variations  in  its  functions  which  follow  a  meal,  in  patients  suffering 
from  the  varied  forms  of  gastric  irritation.  The  brain  sympathises 
with  the  stomach  very  readily,  when  the  former  organ  is  healthy 
and  the  latter  diseased;  but,  when  the  brain  is  previously  diseased, 
we  observe  sympathetic  irritation  to  be  still  more  readily  excited  in 
it  by  a  diseased  stomach,  and,  under  such  circumstances,  the  affec- 
tions of  the  brain  very  quickly  assume  an  alarming,  and  even  fatal 
character. 

When  the  brain  once  begins  to  sympathise  with  an  irritable  sto- 
mach, and  we  witness  alterations  in  the  function  of  the  latter  organ, 
such  as  drowsiness,  headach,  succeeding  a  meal,  or  an  attack  of 
indigestion ;  we  shall  find  that  the  least  circumstance  determines  a 
repetition  of  the  irritation,  and  hence  is  it  that  the  symptoms 
observed  in  the  brain  recur  more  or  less  after  every  full  meal,  whilst 
the  gastric  irritation  lasts.  It  is  this  continued  repetition  of  slight 
irritations,  which  ultimately  lays  the  foundation  in  the  brain  of 
organic  changes,  appearing  slight  perhaps  to  the  mere  pathologist, 
but  which  by  the  irritation  they  produce  in  this  organ  terminate 
ultimately  in  fatal  effusion  or  congestion,  when  the  morbid  state  of 
the  stomach,  from  some  accidental  cause,  becomes  suddenly  worse. 
Case  5  is  an  illustration  of  the  correctness  of  these  remarks.  Most 


lThe  hundred  and  twentieth  aphorism  of  this  Physiologist,  and  his  com- 
mentary upon  it  in  the  Commentaires  des  Propositions,  &e.  t.  i.  p.  153,  are 
well  worthy  of  perusal  on  these  sympathies. 


INFLUENCE  OF   ITS  MORBID  STATES  ON  THE  BRAIN.          173 

of  the  cases,  also,  collected  and  recorded  by  M.  Richond,  in  his  work 
on  the  Influence  of  the  Stomach  upon  the  Production  of  Apoplexy, 
corroborate  the  importance  of  this  proposition. 

The  organic  changes  determined  in  the  brain  by  continued  or 
constantly  repeated  gastric  irritation  are  various ;  they  are  more 
commonly  found  to  consist  in  opacities  of  the  arachnoid,  effusions 
of  turbid  serum,  and  states  of  increased  vascularity  of  the  substance 
of  the  brain.  It  should  be  borne  in  mind,  that  diseases  of  the 
stomach  destroy  life,  riot  so  much  by  the  changes  produced  in  the 
organ  itself,  as  by  the  sympathetic  diseases  which  are  established 
in  the  course  of  years,  in  other  organs,  by  continued  or  constantly 
repeated  irritation  in  the  stomach.  The  stomach  is  necessary  to 
life  from  the  circumstance  that  by  it  the  nutritive  fluid  is  prepared 
which  supports  life.  All  persons,  however,  conversant  with  patho- 
logic researches,  are  aware  that  the  function  of  digestion  is  some- 
times well  performed  by  a  stomach  frightfully  disorganised,  and 
we  have  no  supposition  of  the  existence  of  disease  until  anatomy 
reveals  it  to  us.  Persons  not  at  all  emaciated,  and  in  whom  ail 
the  functions  appear  to  be  properly  performed,  having  occasionally 
extensive  disease  of  the  mucous  membrane  of  the  stomach.  It  is 
by  the  reaction  of  the  stomach  upon  other  organs  that  life  is  com- 
monly destroyed;  by  the  production  of  diseases  which  tend  to  fatal 
terminations  in  organs  more  important  to  life  than  the  stomach, 
as  the  lungs,  heart  and  brain. 

I  have  brought  forward  numerous  cases  in  the  several  divisions 
of  this  work,  illustrating  these  points. 

Whilst,  however,  the  sympathetic  diseases  produced  by  the  sto- 
mach, in  organs  essential  to  life,  render  the  condition"  of  these 
organs  special  objects  of  attention,  it  must  be  remembered  that  the 
state  of  the  stomach  which  produced  them  demands  equal  atten- 
tion; since,  whilst  the  latter  remains,  the  sympathetic  irritations 
will  be  constantly  disposed  to  recur,  as  long  as  their  exciting 
cause  remains. 


CHAPTER  XIII. 

OF     THE     TREATMENT. 

THE  treatment  of  diseases  of  the  stomach  may  be  divided  into 
two  grand  sections — dietetic  and  medicinal.  Of  the  former  enough 
has  been  said  in  the  writings  of  Paris,  Johnson,  Wilson  Philip, 
Abernethy,  and  others,  to  render  a  recurrence  to  it  here  unneces- 
sary; the  latter  must  be  framed  to  suit  the  particular  group  of 
symptoms  manifested  by  different  individuals;  and  for  this  purpose, 
we  shall  distribute  the  symptoms  into  several  classes,  taking  the 


174  PARKER  ON  THE  STOMACH. 

predominant  symptoms  which  demand  the  chief  attention  as  the 
type  of  disease  in  the  class  to  which  it  belongs. 

1.    Of  the  treatment  of  those  forms  of  stomach  disease  whose  prominent 
symptoms  are  pain  and  constipation. 

In  the  affections  of  the  stomach  which  are  characterised  by 
these  two  predominant  symptoms,  we  have  internal  pain  of  a  more 
or  less  violent  character,  occurring  at  various  periods  after  a  meal, 
which  sometimes  increases  to  such  an  extent  as  hardly  to  leave  the 
patient  free  for  an  hour,  the  pain  occasioned  by  one  meal  not 
having  subsided,  before  it  it  is  again  called  forth  by  a  second. 
These  forms  of  disease  are  commonly  accompanied  by  constipa- 
tion, which  invariably  aggravates  the  patient's  state;  and  yet  the 
common  forms  of  aperient  remedies  cannot  be  borne,  on  account 
of  the  great  additional  disturbance  they  create.  I  will  detail  a 
case  as  a  type  of  this  class  of  symptoms: — A  lady,  aged  forty-two, 
had  been  subject  to  attacks  of  pain  after  food  for  fifteen  years,  they 
were  now  increased  to  such  an  extent  that  she  was  never  free 
from  distress,  mixed  food  produced  agonising  pain,  and  even  thin 
cold  gruel  occasioned  considerable  uneasiness.  The  bowels  were 
obstinately  confined,  she  passed  three  or  four  days  without  an 
evacuation,  which  was  then  only  artificially  induced;  the  tongue 
was  red  and  smooth,  the  pulse  frequent;  the  epigastrium  was 
scarcely  sensible  to  pressure.  She  had  emaciated  much  during 
the  two  months  previous  to  my  attendance.  Leeches  and  counter- 
irritants  were  used  to  the  epigastric  region  without  much  relief, 
but  the  patient  lost  all  pain,  the  bowels  were  relieved,  and  in  a  few 
weeks  she  was  completely  established  by  confining  her  to  farina- 
ceous and  milk  diet,  and  giving  the  following  medicines.  R.  Pulv. 
rhaei  gr.  iv.,  morphise  muriatis  gr.  yV  M.  ft.  pil.  ter  die  sumend : 
c.  cochlear.  iij.  larg.  rnisturae  sequent.  R.  Infus.  cascarillee  3  vii., 
magnes.  sulphatis  g  ss,  magnes.  carb.  pond.  3  iss,  tinct.  aloes,  gss, 
acidi  hydrocyanic!  tflxv.,  tinct.  humuli  3  ii.  M.  capital  cochlear.  iij. 
larg.  ter  die.  These  medicines  acted  freely,  without  occasioning 
pain  or  any  uneasiness.  They  were  employed  by  the  patient  for 
three  months  with  the  greatest  benefit,  occasionally  increasing  the 
quantity  of  morphia. 

I  have  not  found  material  benefit  from  leeches  in  such  forms 
of  disease  as  these,  nor  generally  from  counter-irritants.  I  believe 
the  best  of  the  latter  that  can  be  employed  are  blisters,  powdering 
the  denuded  surface  of  the  latter  with  a  grain  or  more  of  the  ace- 
tate or  muriate  of  morphia.  I  have  seen  a  number  of  cases  of 
constipation  of  this  kind,  which  have  been  aggravated  by  drastic 
and  cold  saline  aperients,  yield  almost  magically  to  the  combina- 
tion I  have  just  mentioned.  Enemas  had  also  been  totally  ineffi- 
cient in  relieving  the  constipation.  These  forms  of  disease  appear 
dependent  upon  a  slight  inflammatory  affection  of  the  stomach 
occurring  in  patients  of  great  nervous  susceptibility;  sometimes 


INFLUENCE  OP  ITS  MORBID  STATES  ON  THE  BRAIN.         175 

they  are  accompanied  by  tenderness  in  the  epigastrium,  a  red, 
loaded  tongue,  frequency  of  pulse,  and  evening  accessions  of  fever, 
whilst  at  others,  the  tongue  is  pale,  the  pulse  small,  but  not  fre- 
quent, the  skin  cold,  and  tenderness  in  the  epigastrium  entirely 
absent.  In  the  former  of  this  class  of  symptoms,  I  should  consider 
the  disease  one  of  sensibility,  combined  with  a  trivial  degree  of 
inflammatory  action  ;  in  the  second,  a  disease  of  sensibility  alone. 
To  the  former  of  these  diseases,  Barras  has  applied  the  term  "gas- 
tro-enteralgie  avec  lagastro-enterite  chronique;"  certainly,  in  many 
cases,  the  symptoms  of  inflammation  are  decidedly  present,  whilst 
in  others  the  disease  of  sensibility  exists  without  this  complication. 
In  the  former  state  small  local  depletions  are  of  service,  but,  if  the 
loss  of  blood  be  large,  the  nervous  symptoms  are  invariably  aggra- 
vated ;  three,  four,  or  six  leeches  applied  from  time  to  time  are 
of  great  service ;  a  larger  number  frequently  increase  the  pain, 
and  add  to  the  debility  of  the  patient,  which  if  the  disease  has 
continued  a  long  time,  is,  in  many  cases,  very  great.  The  con- 
stipation should  be  relieved  by  the  form  of  remedy  I  have  given, 
or  a  similar  one.  The  following  I  have  found  of  great  service, 
leeching,  or  blistering,  the  epigastrium  at  the  same  time,  if  ten- 
derness be  present. 

R  Magnes.  carb.  pond.  3i.,  bismuth  subnitratis  gr.  v.,  morphiae 
muriatis  gr.  £  11^  ft.  pulvis  ter  die  snmendus. 

This  is  chiefly  useful  after  the  constipation  has  been  removed. 
After  the  bowels  have,  by  appropriate  treatment,  been  brought  to 
act  well  without  medicine,  and  the  whole  of  the  symptoms  of  in- 
flammatory disease  have  subsided,  a  combination  of  the  muriate  or 
the  acetate  of  morphia  with  the  carbonate  or  sulphate  of  iron  ;  or 
the  syrup  of  morphia  with  the  muriate  or  the  ammoniated  tincture 
of  iron,  will  generally  be  found  serviceable  in  preventing  the 
recurrence  of  pain. 

The  indications  under  this  head  are  to  remove  pain,  to  obviate 
constipation,  by  which  it  is  invariably  aggravated,  to  subdue  con- 
comitant inflammatory  action,  and  to  enable  the  stomach,  when 
these  intentions  have  been  accomplished,  to  fulfil  its  offices  again 
properly. 

2.  The  treatment  where  vomiting  and  diarrhoea  are  the  predominant 

symptoms. 

In  many  cases  these  symptoms  exist  together,  or  vomiting  comes 
on  occasionally,  when  an  habitual  state  of  relaxed  bowel  is  con- 
stantly present.  In  other  cases,  vomiting  may  be  present  with 
constipation,  or  diarrhoea  may  exist  without  vomiting.  In  the 
great  majority  of  instances,  both  these  symptoms  are  dependent 
upon  a  chronic  irritation  of  the  gastro-intestinal  mucous  mem- 
brane, of  the  inflammatory  kind.  It  is  a  common  circumstance  to 
find  persons,  indulging  in  the  pleasures  of  the  table,  with  bowels 
constantly  relaxed,  at  the  same  time  they  have  total  loss  of  appe- 


176  PARKER  ON  THE  STOMACH. 

tite,  whilst  the  tongue  is  foul,  the  papillae  elevated,  and  the  front 
and  edges  of  the  organ  vividly  red.  At  times  headach  or  thirst  is 
added  to  the  other  symptoms.  The  most  simple  aperient  in  many 
of  these  cases  will  produce  profuse  evacuation.  I  have  noted 
many  of  these  cases  continuing  for  months  together.  Suddenly 
the  symptoms  of  acute  gastritis  have  been  manifested,  and  the  epi- 
gastrium, which  was  not  before  tender,  has  become  so  sensible  that 
the  slightest  pressure  could  hardly  be  borne. 

A  gentleman,  aged  forty-eight,  had  suffered  from  this  state  for 
many  months,  his  bowels  were  habitually  relaxed,  two  or  three 
loose  evacuations  daily;  a  small  dose  of  rhubarb  or  magnesia  pro- 
duced six  or  seven  stools,  he  had  no  appetite,  and  a  loaded  tongue, 
vividly  red  at  the  point  and  edges.  He  had  not  the  least  epigas- 
tric tenderness.  At  times  severe  vomiting,  with  increased  diar- 
rhoea, would  come  on,  unattended  by  pain,  in  which  state  he  found 
relief  from  a  combination  of  blue  pill  with  opium,  and  the  mist, 
cretce  with  conf.  opii,  and  hydrocyanic  acid.  These  symptoms 
suddenly  assumed  an  acute  form,  he  had  fever  and  acute  pain  in 
the  epigastrium,  pressure  in  this  region  could  hardly  be  borne, 
whilst  every  thing  taken  into  the  stomach  produced  most  severe 
pain.  These  symptoms  were  subdued  by  daily  relays  of  leeches, 
at  the  same  time  the  patient  took  internally  the  hyd.  c.  creta  with 
p.  ipecac,  co.  and  the  hydrocyanic  acid  in  almond  emulsion.  Un- 
der this  plan  the  appetite  became  good,  the  tongue  clean,  and  the 
bowels  lost  that  disposition  to  irritability  which  they  exhibited  be- 
fore the  appearance  of  the  acute  attack. 

In  all  cases  of  this  kind,  the  great  point  in  the  treatment  is  to 
allay  the  irritability  of  the  mucous  surfaces  by  mild  opiate,  antacid, 
or  absorbent  remedies;  no  active  measures  should  be  resorted  to, 
they  invariably  aggravate  the  patient's  condition  ;  a  mild,  unstimu- 
lating,  nutritious  diet,  consisting  of  milk  and  farinaceous  aliments, 
with  such  medicines  as  the  hyd.  c.  creta,  with  p.  ipecac,  co.,  two 
grains  of  the  former  with  one  of  the  latter  for  a  dose,  the  carbonate 
of  soda  with  morphia  if  much  acidity  be  present,  or  a  gram  or  two 
of  rhubarb  with  the  same  anodyne,  are  the  best  and  safest  reme- 
dies to  be  employed  ;  the  hydrocyanic  acid  also  may  be  given  with 
these  remedies  in  the  raistura  cretae.  Should  the  epigastrium 
become  tender,  it  must  be  leeched  ;  after  the  repetition  of  local 
depletion  two  or  three  times,  if  the  tenderness  continues,  without 
much  heat  of  skin,  blisters  may  be  employed,  and  the  surface  pow- 
dered with  morphia,  or  dressed  with  an  ointment  containing  three 
or  four  grains  of  this  salt  to  the  ounce. 

It  is  this  form  of  gastro-intestinal  irritation  which  so  frequently 
precedes  the  development  of  hepatic  and  pulmonary  diseases. 
Andral  has  noticed  the  tendency  to  irritation  in  the  lungs  of 
patients  so  affected.  I  have  collected  the  cases  of  several  indi- 
viduals, who  seem  disposed  to  hepatic  diseases,  and  who,  if  these 
irritations  are  suffered  to  remain  unchecked,  speedily  become 
jaundiced. 


ON  THE  TREATMENT.  177 


3.  Treatment  of  the  more  acute  forms,  characterised    by  great  epigastric 
tenderness  and  irritability  of  the  vascular  system. 

When  we  find  the  more  acute  forms  of  gastric  inflammation, 
arising  in  persons  predisposed  to  great  vascular  excitement,  with 
increased  heat  of  skin,  accelerated  pulse,  throbbing  of  the  heart, 
and  giddiness  after  a  meal,  continuing  during  the  whole  period  of 
digestion,  and  accompanied  by  great  sensibility  of  the  epigastrium, 
our  first  treatment  must  consist  in  the  local  abstraction  of  blood 
from  this  region  ;  this  should  be  continued  daily  in  small  quanti- 
ties proportionate  to  the  strength  of  the  patient,  whilst  any  heat 
or  tenderness  remains,  or  whilst  the  arterial  system  is  excited  by 
taking  food.  In  the  intervals,  the  stomach  should  be  covered  by 
a  fomentation  of  hops,  poppies,  or  an  aqueous  solution  of  opium, 
whilst  we  limit  the  patient  to  a  strict  dietetic  discipline — tepid 
gruel,  or  thin  farinaceous  food ;  and  give  him  internally  such  reme- 
dies as  the  following: — R.  acid  nitro-muriatici  M.  xl.,  morphias 
muriatis  gr.  £  to  gr.  j.,  syr.  simp.  §  i.,  aquae  distillatas  g  vii.,  M.  capt. 
cochlear.  iij.  larg.  4  tis  horis.  These  are  exactly  the  forms  of 
gastric  inflammation,  which  Broussais  has  taken  as  a  type  of  the 
whole  series;  and  here  we  agree  with  him  that  aperient  medicines 
are  decidedly  hurtful,  not  only  augmenting  the  tendency  to  irrita- 
tation  of  the  stomach  itself,  but  also  increasing  the  vascular  excite- 
ment, and  disposition  to  the  occurrence  of  sympathetic  affections 
of  other  organs,  as  the  heart  and  brain. 

A  gentleman,  about  45  years  of  age,  had  suffered  from  vomit- 
ing, flatulence,  and  fulness  after  his  meals,  for  some  time,  with 
tenderness  and  great  heat  in  the  epigastrium,  acceleration  of  pulse, 
throbbing  of  the  carotids,  palpitation,  stupor,  giddiness,  and  ina- 
bility to  think  after  having  eaten.  The  daily  application  of  leeches 
to  the  epigastrium  relieved  the  symptoms  to  convalescence;  at 
the  same  time  the  patient  took  internally  the  mixture  prescribed 
above.  In  this  case  a  tea-cupful  of  food  (even  gruel)  brought 
on  the  symptoms  in  their  usual  form.  There  are  two  remarkable 
points  illustrated  by  this  case:  the  inflammatory  form  of  a  great 
majority  of  cases  of  simple  indigestion,  marked  in  the  first  in- 
stance by  mere  fulness  after  a  meal,  which  was  the  primary 
symptom  in  this  case;  and  the  great  importance  of  limiting  the 
patient,  in  such  diseases  as  the  present,  to  just  so  much  food  as 
may  be  digested  with  comfort,  without  stimulating  the  mucous 
coats  of  the  stomach  to  a  degree  which  may  excite  the  heart  or 
arterial  system.  In  such  forms  of  disease  as  the  present,  the  mode 
of  local  bleeding  proposed  by  Roche  might  be  adopted  with  great 
benefit — i.  e.,  to  apply  leeches  to  the  epigastric  region,  at  the 
periods  only  when  the  febrile  or  arterial  excitement  comes  on ; 
for,  in  many  instances,  this  is  only  manifested  after  the  periods  of 
taking  food.  In  the  intervals,  the  patient  is  comparatively  well; 
hence,  the  great  point  in  the  treatment  is  to  diminish  the  excita- 
12— d  park  12 


178 


PARKER  ON  THE  STOMACH. 


bility  of  the  stomach  to  impression  at  the  time  when  food  is  taken 
into  it.  Dr.  Roche  was  of  opinion  that  the  inflammatory  condi- 
tion of  the  stomach,  and  the  irritability  consequently  manifested, 
was  not  much  relieved  by  bleeding  in  the  intervals  of  the  acces- 
sions of  vascular  excitement,  which  were  manifested,  as  in  the 
present  instance,  after  a  meal. 

4.  Treatment  where   fulness,  distension   and   acidity,  with  flatulence  and 
eructations  after  eating,  are  the  predominant  symptoms. 

To  this  class  of  symptoms  the  term  indigestion  is  most  fre- 
quently applied.  These  symptoms  mark  a  condition  of  the  stomach 
in  which  active  hyperemia,  or  morbid  fulness  of  blood,  not  amount- 
ing to  inflammation,  is  the  pathologic  character  of  the  disease. 
This  is  the  first  step  to  chronic  gastritis,  but  it  is  not  the  disease. 
In  these  forms,  when  the  stimulus  of  food  is  absent,  the  coats  of 
the  stomach  return  to  their  customary  state,  and  the  patient  is  well 
till  another  full  meal  brings  on  again  the  congested  condition  of 
its  mucous  membrane.  Taking  this  condition  of  the  stomach  as 
one  of  its  primary  morbid  states,  we  may  see  how  easy  is  the  pro- 
gression into  confirmed  chronic  inflammation,  and  its  terminations 
in  changes  of  colour  and  consistence,  softening,  ulceration,  or 
cancer.  The  treatment  of  this  form  of  disease  must  depend,  in  a 
great  measure,  upon  the  addition  of  other  symptoms  to  the  pre- 
dominant ones,  just  now  detailed,  such  as  pain  after  food,  epigas- 
tric tenderness,  diarrhoea,  or  constipation.  If  the  epigastric  ten- 
derness be  not  marked,  and  the  bowels,  as  they  commonly  are,  full 
and  confined,  we  may  commence  the  treatment  by  removing  the 
use  of  stimulants  from  the  plan  of  alimentation,  and  limiting  the 
patient  to  milk  and  easily  digestible  food.  It  is  here  that  aperi- 
ents, judiciously  administered,  are  of  great  service;  but  we  must 
bear  one  thing  in  mind  in  their  exhibition,  viz.,  that  the  stomach 
and  bowels  being  in  a  morbid  state,  are  particularly  sensible  to  im- 
pression, in  these  forms  of  disease ;  and  hence  the  administration 
of  purgative  medicines,  although  clearly  indicated  and  properly 
chosen,  is  sometimes  followed  by  a  degree  of  relaxation  of  the 
bowels  approaching  to  hypercatharsis.  I  have  seen  this  state  pro- 
duced over  and  over  again,  when  the  symptoms  of  hyperemia  of 
the  stomach  were  present,  and  the  bowels  at  the  same  time  con- 
fined. For  the  same  reason  does  digitalis  produce  vomiting  when 
exhibited  in  this  state  of  the  stomach,  complicated  with  disease  of 
the  heart.  Stimulant  diuretics  in  dropsies  or  hepatic  diseases  are 
productive  of  the  same  evils,  where  this  state  of  stomach  is  present. 
The  forms  of  aperient  remedies  I  am  generally  in  the  habit  of  em- 
ploying in  these  states  are  the  following: — R.  Pil.  hyd.  gr.  ii., 
pulv.  rhaBi  gr.  iii.,  ipecac,  co.  gr.  i.,  mucilaginis  q.  s.  ft.  pil.  ii. 
These  may  be  taken  twice  or  thrice  a  day,  with  two  or  three  table- 
spoonfuls  of  the  mixture  prescribed  in  the  first  section.  If  the 
flatulence  be  distressing,  a  combination  of  the  pil.  hydr.  with  the 


ON  THE  TREATMENT.  179 

pil.  galbani  co.  is  of  great  service.  At  other  times,  the  blue  pill 
may  be  used  with  the  extract  of  hyoscyamus.  These  remedies 
should  be  given  with  different  proportions  of  the  mixture,  accord- 
ing to  the  circumstances  of  the  case.  1  have  found  great  benefit 
from  exhibiting  the  pills  and  mixture  one  hour  before  dinner,  once 
in  the  day,  and  repeated  before  the  evening  meal,  if  the  bowels 
require  it. 

If  much  tenderness  and  pain  exist  in  the  epigastrium,  if  the 
pulse  be  full  and  hard,  the  tongue  red  and  dry,  small  relays  of 
leeches  will  be  of  great  use.  I  have  frequently  cured  these  indi- 
gestions by  this  remedy  alone;  four  or  six  leeches,  every  two  or 
three  days,  applied  during  the  period  of  digestion,  requesting  the 
patient,  at  the  same  time,  to  abstain  from  all  stimulating  aliments, 
and  to  live  upon  thickened  milk,  sago,  or  farinaceous  food,  sub- 
stituting cocoa  for  coffee  or  tea. 

Much  stress  is  laid  by  the  French  physicians  on  the  use  of 
mucilaginous  and  acidulated  drinks  during  active  hyperemias,  or 
inflammatory  states  of  the  mucous  coats  of  the  stomach.  This  is 
a  treatment  which  is  too  much  neglected  in  this  country,  as  well 
as  that  of  anodyne  fomentations  to  the  epigastrium.  The  experi- 
ments of  Dr.  Beaumont1  show  that,  during  fits  of  repletion  or  of 
gastric  derangement,  from  over  stimulating  or  other  causes,  or 
during  feverish  states  of  the  constitution,  the  mucous  coat  of  the 
stomach  becomes  dry  and  covered  by  red  patches;  this  is  the  state 
that  may  be  supposed  to  occur  two,  three,  or  four  hours  after  a  full 
meal,  the  period  of  its  occurrence  being  marked  by  thirst.  This 
condition  of  the  mucous  coat  is  also  present  during  ordinary  fits 
of  indigestion,  and  hence  the  propriety  of  defending  the  sentient 
extremities  of  the  gastric  nerves  from  the  rude  impression  of 
alimentary  substances,  when  the  stomach  is  in  this  state,  by  mild 
tepid  acidulous  or  mucilaginous  drinks,  taken  in  small  quantities. 
Broussais  assures  us  that  he  has  frequently  prevented  the  passage 
of  mere  indigestion,  of  the  inflammatory  form,  into  confirmed 
gastritis,  by  exhibiting  small  portions  of  drinks  of  this  character 
during  the  accession  of  the  fits  of  indigestion  after  a  meal.  We 
know  that  the  sentient  extremities  of  all  nerves,  throughout  the 
economy,  must  be  kept  in  a  moist  state,  in  order  that  they  may  be 
enabled  to  fulfil  their  customary  functions.  For  this  purpose,  we 
find  the  extreme  branches  of  all  nerves  covered  by  particular 
fluids.  If  these  fluids  be  dried  up,  the  nerve  no  longer  transmits 
a  true  impression  to  the  brain,  and  its  organic,  as  well  as  its 
animal  sensibility  becomes  destroyed,  or  morbidly  exalted.  Itard 
has  attributed  one  species  of  deafness  to  absence  of  the  fluid  in 
which  the  extremities  of  the  auditory  nerves  are  distributed,  in  the 
semicircular  canals  and  cochlea,  in  the  internal  ear. 

I  do  not  think  that  revulsives,  such  as  blisters,  the  tartar  emetic 

'Experiments  and  Observations  on  the  Gastric  Juice  and  the  Physiology 
of  Digestion.  Plattsburg,  1833. 


• 
180  PARKER  ON  THE  STOMACH. 

ointment,  or  plaster,  or  frictions  with  croton  oil  are  generally 
beneficial  in  affections  of  the  stomach  of  this  character,  in  fact  in 
diseases  of  this  order  generally,  unless  the  disease  be  perfectly 
apyretic.  I  have  seen  them,  if  applied  whilst  any  vascular  excite- 
ment is  present,  productive  of  great  mischief. 

The  outline  of  the  treatment,  given  by  Dr.  Stokes,  of  chronic 
gastritis,  in  the  article  of  that  name  in  the  Cyclopaedia  of  Practical 
Medicine,  is  well  suited  to  the  incipient  forms  of  inflammatory 
indigestion.  This  consists  in  small  local  bleedings,  diet,  and  seda- 
tives, such  as  the  salts  of  morphia,  and  hydrocyanic  acid.  Tho 
combination  of  these  two  latter  remedies,  in  various  forms,  with 
mild  aperients,  is,  however,  of  singular  use  in  various  forms  of 
disease  of  the  stomach.  I  have  given  some  forms  of  combination 
in  which  these  remedies  may  be  employed.  Dr.  Chauffard,  of 
Avignon,1  employs  chiefly,  in  these  forms  of  indigestion  or  gastric 
hyperemia,  small  bleedings,  with  anodyne  or  acidulous  drinks. 
He  appears  to  have  been  very  successful  in  his  treatment  of  die 
inflammatory  forms  of  indigestion. 

I  shall  now  offer  a  few  remarks  on  the  principal  remedies 
employed  in  diseases  of  the  stomach. 

Bleeding,  general  and  local. — General  bleeding  in  diseases  of 
the  stomach,  even  of  the  inflammatory  kind,  is  inadmissible,  except 
perhaps  in  very  severe  forms  of  acute  gastritis,  where  a  single 
bleeding  might  be  employed  at  the  commencement  of  the  treat- 
ment, prior  to  local  depletions  from  the  epigastrium.  The  testi- 
mony of  most  authors  is  against  general  bleeding.  Broussais  was 
singularly  unsuccessful  in  its  employment,  even  in  cases  of  acute 
disease,  which  we  shall  see  by  reference  to  his  cases  thus  treated.2 
Local  bleeding  is,  on  the  contrary,  one  of  the  most  efficacious 
remedies  that  can  be  employed  in  all  affections  of  this  kind.  It 
should  not  precede  the  use  of  other  remedies,  but  when  these 
seem  to  be  productive  of  little  benefit,  or  mere  temporary  amend- 
ment, judicious  local  depletion  from  the  epigastrium  should  be  em- 
ployed. This  remedy  may  be  resorted  to  in  all  cases  where  ful- 
ness of  blood  in  the  mucous  coat  of  the  stomach  is  suspected,  from 
whatever  cause  it  may  arise  :  even  in  cases  of  extreme  emaciation 
from  long  continued  disease,  two,  three,  or  four  leeches  will  some- 
times alleviate  symptoms  which  no  medicine  will  benefit.  In 
cases  of  acute  inflammation,  leeches  may  be  employed  freely  to 
the  number  of  fifteen  or  twenty  at  each  time.  If,  however,  acute 
or  sub-acute  gastritis  arise  during  the  progress  of  an  affection  of 
the  heart  or  the  liver,  the  depletion  must  be  more  cautiously  em- 
ployed, recollecting  that  we  have  to  deal  with  a  constitution  already 
enfeebled,  or  rendered  irritable  in  consequence  of  long  continued 
disease.  In  cases  of  confirmed  chronic  inflammation  of  the  sto- 
mach, more  benefit  will  be  derived  from  the  daily  application  of 

*De  la  Saignee,  et  des  Emolliens  dans  les  Indigestions. 
*  Cases  5,  6,  7,  art.  Influence  of  the  stomach  upon  the  lungs. 


ON  THE  TREATMENT.  181 

small  relays  of  leeches  to  the  number  of  six  or  eight,  than  from 
one  large  depletion  where  more  are  employed.  I  consider  the 
quantity  of  blood  taken  at  a  time  in  cases  of  this  kind  to  be  of 
extreme  importance.  Unpleasant  nervous  symptoms  very  com- 
monly accompany  diseases  of  the  stomach  of  the  inflammatory 
kind,  and  a  trifling  degree  of  inflammation  sometimes  produces  an 
affection  in  which  the  nervous  symptoms  predominate  over  the  in- 
flammatory ;  hence  local  depletion,  although  of  vast  utility,  should 
be  employed  with  care  and  caution,  for  it  is  a  very  common  cir- 
cumstance to  see  large  depletions  of  this  kind  succeeded  by  an 
aggravation  of  the  concomitant  nervous  symptoms.  The  largo 
local  bleedings  resorted  to  by  Broussais,  and  the  physicians  of  the 
French  physiologic  school,  have  been  productive  of  infinite  mis- 
chief. If  we  peruse  carefully  the  work  of  Barras,  Des  Gastral- 
gies  et  des  Enteralgies,  we  shall  be  convinced  that  many  of  the 
cases  related  by  him  of  nervous  affections  of  the  stomach  and 
bowels  were  the  result  of  large  local  bleedings,  the  use  of  fifty, 
sixty,  or  even  eighty,  and  a  hundred  leeches  at  each  application. 
Many  of  the  examples  reported  by  M.  Barras,  which  are  considered 
by  him  merely  nervous  diseases,  and  which  were  so  at  the  time  he 
was  consulted,  requiring  nothing  but  full  diet  and  steel  for  their 
cure,  were,  in  the  commencement,  diseases  of  the  inflammatory 
kind,  the  patient  having  been  rendered  irritable  and  nervous  by 
the  large  bleedings  and  rigid  abstinence  employed  at  the  com- 
mencement of  the  treatment.  De  Larroque,  whilst  he  illustrates 
the  utility  of  moderate  depletions  from  the  epigastrium  in  inflam- 
matory diseases  of  the  stomach,  irritating  the  lungs,  loudly  ex- 
claims against  the  large  local  bleedings  practised  by  many  of  the 
physicians  of  the  physiologic  school.  The  period  of  bleeding  is 
also  of  importance.  Many  forms  of  gastritis  are  strictly  periodical; 
in  others,  the  prominent  features  of  the  disease,  as  pain  and  disten- 
sion of  the  stomach,  heat  of  skin,  and  quickened  circulation  are 
only  present  after  meals.  It  is  during  these  accessions  that  bleed- 
ing should  be  employed;  it  is  at  these  periods  very  much  more 
useful  both  as  a  palliative  and  curative  remedy,  both  in  producing 
present  relief,  and  preventing:  the  recurrence  of  future  attacks,  than 
when  resorted  to  at  other  times  in  the  intervals  of  the  exacerba- 
tions of  disease. 

Aperients. — Many  physicians  appear  to  regard  all  gastric  irrita- 
tions as  mere  suburral  states,  and  consequently  employ  strong  dras- 
tric  aperients  for  their  cure.  By  others,  all  aperient  remedies  are 
condemned,  as  likely  still  more  to  excite  a  membrane  already  red- 
dened by  irritation.  I  have  shown  that  there  are  many  forms  of 
stomach  disease,  in  which  constipation  is  a  prominent  and  distress- 
ing symptom,  adding  materially  to  the  inconvenience  and  suffer- 
ing of  the  patient;  in  such  cases,  although  aperients  are  indicated, 
and  of  the  greatest  utility  when  properly  selected,  they  frequently 
add  to  the  disease  and  suffering:  already  present,  if  violent  and  not 
combined  with  sedatives.  The  best  aperients  that  can  be  used  in 


182 


PARKER    ON    THE    STOMACH. 


these  diseases  are  combinations  of  the  pil.  hydrargyri  with  rhubarb 
or  aloes,  combined  with  the  pil.  galbani  co.,  the  extracts  of  hops, 
lettuce,  or  hyoscyamus,  or  the  salts  of  morphia.  Calomel,  com- 
bined with  the  pil.  aloes  cornp.  and  some  sedative,  is  also  in  certain 
cases  useful.  The  proportion  of  the  mecurial  for  each  dose  should 
rarely  exceed  one  grain.  These  remedies,  with  solutions  of  the 
neutral  salts  in  bitter  infusions,  to  which  the  hydrocyanic  acid  is 
added,  are  the  forms  of  aperient  which  I  have  invariably  found 
most  useful;  they  operate  freely  without  pain  or  uneasiness,  and 
generally  afford  the  patient  very  marked  relief. 

Sedatives. — This  is  an  important  class  of  remedies  in  diseased 
conditions  of  the  mucous  membrane  of  the  stomach.  In  all  forms 
of  inflammation,  there  is  mostly  an  exalted  state  of  the  sensibility 
of  the  part  inflamed.  The  peculiar  organisation,  however,  of  cer- 
tain nerves,  particularly  those  of  the  ganglionic  system,  and  the 
system  of  the  par  vagum,  render  the  exalted  sensibilities  of  the 
mucous  surfaces  of  the  stomach  and  intestines  inappreciable  by 
the  brain,  unless  they  pass  a  certain  limit.  Hence,  in  some  in- 
stances, inflammatory  disease  of  these  organs  proceeds  to  actual 
disorganisation,  without  the  patient  being  aware  of  its  existence; 
whilst,  in  others,  a  slight  degree  of  inflammation  will  produce  in- 
tense febrile  excitement.  It  is  from  a  knowledge  of  the  peculiar 
sensibilities  of  these  parts  that  we  may  see  the  great  use  of  seda- 
tives in  the  treatment  of  their  inflammatory  or  other  forms  of  dis- 
ease; and  it  is,  also,  from  this  circumstance,  that  I  never  prescribe 
an  aperient  remedy  in  diseased  conditions  of  the  stomach,  without 
combining  it  with  some  preparation  of  morphia,  the  hydrocyanic 
acid,  or  the  extract  of  henbane.  The  best  sedative  that  can  be 
employed  is  the  muriate  of  morphia.  In  all  inflammatory  affections 
of  the  stomach,  this  remedy,  combined  with  aperients  or  with  alka- 
lies, or  given  merely  to  allay  pain  or  irritability,  is  of  great  use. 
Others,  however,  may  be  given  according  to  circumstances,  such 
as  the  acetate  of  morphia,  the  hydrocyanic  acid,  the  lip.  opii  seda- 
tivus,  or  the  extracts  of  hop,  lettuce,  or  henbane.  These  are  the 
chief  sedatives  of  use  in  such  affections,  and  perhaps  they  answer 
all  the  necessary  indications.  They  are  generally  more  useful  in 
combination  with  alkalies  or  aperients  than  when  given  simply  and 
uncombined.  The  external  application  of  sedative  remedies  to  the 
epigastric  region,  in  many  painful  affections  of  the  stomach,  I  have 
found  of  very  great  service,  whether  these  affections  are  primitive, 
or  whether  they  result  from  organic  change.  In  cases  of  extreme 
thicknening  of  the  coats  of  the  stomach,  of  a  scirrhoid  character, 
where  the  suffering  patients  are  almost  worn  out  with  constant 
pain,  such  remedies,  applied  over  the  epigastrium,  most  materially 
alleviate  the  distress.  We  have  no  hope,  in  many  of  these  deplo- 
rable cases,  of  eradicating  or  curing  the  disease;  but  still  we  may 
afford  great  ease  to  the  patient,  enable  him  to  follow  some  gentle 
occupation,  and  to  digest  a  mild  unirritating  food  without  pain, 
and  even  with  comfort.  In  many  forms  of  disease,  a  piece  of 


ON    THE    TREATMENT.  183 

flannel  soaked  in  a  strong  solution  of  opium,  and  worn  over  the 
epigastrium,  affords  great  relief;  or,  what  is  more  efficacious,  a 
solution  of  from  two  to  four  drachms  of  the  extract  of  belladonna 
in  six  or  eight  ounces  of  water,  to  be  used  tepid  as  an  application 
to  the  part.  A  poultice  of  the  leaves  may  be  also  applied,  or  one 
of  hyoscyamus,  hop,  or  poppy.  These  remedies  are  highly  ser- 
viceable in  all  diseases  of  the  stomach  accompanied  by  pain.  They 
may  be  employed  with  equal  service  in  acute  inflammatory  affec- 
tions of  this  organ,  or  where  gastric  irritation  occurs  as  a  compli- 
cation in  fevers  and  inflammatory  diseases  generally. 

Antacids  and  Absorbents. — We  learn  from  the  researches  of 
Prout,  Tiedeman  and  Gmelin,  and  Dr.  Beaumont,  that  the  gastric 
juice,  during  digestion,  contains  free  hydro-chloric  and  acetic  acids, 
and  that  these  acids  are  furnished  in  greater  quantity  in  direct  pro- 
portion to  the  more  or  less  stimulating  qualities  of  the  food.  Under 
a  mild  farinaceous  diet  these  acids  are  barely  detected.  Many  dis- 
eased conditions  of  the  stomach  are  accompanied  by  this  increased 
generation  of  acid  in  its  secretions,  and  in  some  instances  intense 
acidity  after  food  forms  one  of  the  most  prominent  and  distressing 
features  of  the  complaint.  Great  intestinal  irritability  also  frequently 
accompanies  this  disposition  to  the  formation  of  acid  in  the  stomach, 
and  the  patient  is  commonly  tormented  with  tenesmus,  or  purging 
of  small,  watery,  hot  stools.  In  these  cases  it  becomes  necessary 
to  administer  remedies  to  neutralise  this  excess  of  acid,  as  well  as 
to  adopt  others  to  prevent  the  disposition  to  its  recurrence.  The 
mistura  cretse  of  the  London  Pharmacopeia,  given  with  large 
doses  of  hydrocyanic  acid,  is  here  particularly  serviceable,  more 
especially  in  those  forms  in  which  intestinal  irritation  is  present. 
I  have  found  this  combination  of  remedies  of  singular  service  in 
gastric  diseases  attended  with  a  profuse  secretion,  or  formation  of 
acid.  At  other  times,  the  ponderous  carbonate  of  magnesia,  or 
soda,  combined  with  morphia  and  the  sub-nitrate  of  bismuth,  may 
be  employed. 

Tt  occasionally  happens,  that  intense  acidity  accompanies  or  suc- 
ceeds to  a  state  of  great  bodily  weakness,  particularly  when  this  is 
the  result  of  large  losses  of  blood,  as  in  the  cases  I  have  detailed  in 
the  section  of  the  work  on  Diseases  of  the  Stomach  produced  by 
Anemia.  Here  the  condition  of  the  stomach  is  dependent  upon  that 
of  the  constitution  generally,  and  yields  to  remedies  suited  to  the 
general  affection  upon  which  the  morbid  state  of  the  stomach 
appears  to  depend.  In  these  forms  of  disease,  the  various  prepara- 
tions of  iron  are  eminently  serviceable :  combinations  of  the  car- 
bonate of  iron  with  myrrh  and  rhubarb,  are  perhaps  amongst  the  most 
efficacious  that  can  be  employed. 

Tonics. — There  are  many  forms  of  gastric  disturbance  which 
resemble  hyperemia,  or  inflammation,  which  are  not  benefited,  but 
rather  rendered  worse,  by  a  treatment  framed  to  suit  such  forms  of 
disease;  hence  it  is,  that  we  very  commonly  see  local  depletion  from 
the  epigastrium  and  aperient  medicines  injurious  to  many  affections 


184  PARKER  ON  THE  STOMACH. 

of  the  stomach,  which  we  should  have  supposed,  from  the  symp- 
toms which  they  exhibited,  would  have  been  benefited  by  such 
remedies.  It  is  because  these  symptoms  depend  upon  some  other 
cause,  and  not  upon  hyperemia  or  inflammation,  that  these  remedies 
are  not  successful ;  and  yet  it  is  difficult,  nay  sometimes  impossible, 
to  distinguish  between  vascular  irritations  of  the  stomach  and  other 
affections  of  this  organ,  the  results  of  treatment  being  occasionally 
our  only  guides.1 

It  is  in  many  of  these  states,  that  we  find  tonics  succeeding  where 
an  antiphlogistic  treatment  has  failed,  or  been  positively  hurtful.  I 
subjoin  one  or  two  cases,  by  way  of  example. 

A  gentleman  consulted  me,  complaining  of  unpleasant  symptoms 
connected  with  his  head  and  stomach,  which  invariably  harassed 
him  after  eating,  and  during  the  process  of  digestion.  He  had 
swelling  of  the  stomach,  nausea,  flatulence,  uneasiness  and  tender- 
ness in  the  epigastrium  with  great  drowsiness  and  stupor.  He  took, 
at  first,  combination  of  the  blue  pill  with  rhubarb,  and  the  stomachic 
aperient  mixture  prescribed  at  page  174.  These  remedies  afforded 
no  relief;  the  patient  was  worse  after  their  use,  and  yet  the  symp- 
toms characterising  his  complaint,  both  in  the  head  and  stomach, 
resembled  very  much  a  condition  of  hyperemia  in  both  organs, 
which  we  see  so  frequently  benefited  by  such  a  plan  of  treatment. 
I  now  recommended  the  carbonate  of  iron,  to  be  taken  in  combina- 
tion with  myrrh  and  rhubarb.  The  use  of  these  remedies  for  a  few 
days,  completely  removed  the  affection  of  both  organs.  This  is  not 
a  case  of  rare  occurrence  ;  I  have  repeatedly  noted  cases  of  pain  in 
the  stomach,  with  constipation,  heat,  beatings,  and  tenderness  in  the 
epigastrium,  exactly  resembling  hyperemia  of  the  stomach,  or  the 
nervous  centres  of  the  epigastrium,  aggravated  by  leeches  to  this 
region,  and  the  use  of  aperients,  yield  readily  to  such  remedies  as 
those  I  have  just  noticed. 

I  have  repeatedly  been  consulted  by  a  young  lady,  who  suffered 
constant  pain  in  the  stomach  after  eating ;  at  the  same  time  her 
bowels  were  habitually  constipated,  the  epigastric  region  was  hot 
and  tender,  and  the  seat  of  strong  pulsations  ;  the  tongue  dry  and 
coated,  the  papillae  vivid  and  largely  developed.  No  permanent 
relief  was  afforded  in  this  case  from  local  bleeding  or  aperients  ;  after 
the  complaint  had  been  established  for  some  time  they  were 
injurious.  Great  benefit  was  derived  subsequently  from  the  carbo- 
nate of  iron,  with  myrrh  and  rhubarb. 

Tonics  are  useful  in  many  morbid  states  of  the  stomach;  which 
may  be  referred  to  four  classes  ;— 

1.  Primitive  morbid  conditions,  resembling  inflammatory  affec- 
tions, which  are  aggravated  by  an  antiphlogistic  treatment,  or  by 
aperients. 

2.  States   of  disease,  succeeding  to  inflammation,  which   have 
been  benefited  by  an  antiphlogistic  treatment  in  the  commencement, 

1  See  the  remarks  on  this  subject  at  p.  48. 


ON  THE  TREATMENT.  185 

but  where  this  no  longer  affords  relief,  or  adds  to  the  seventy  of 
the  symptoms. 

3.  Various   morbid   states   of   the   sensibility  of   the   stomach. 
These   are   occasionally   accompanied   by  intermittent  neuralgic 
affections  in  other  parts  of  the  body. 

4.  States  of  general  debility,  and  many  local  symptoms,  as  pain, 
nausea,  and  vomiting,  which  accompany  confirmed  organic  diseases 
of  the  stomach. 

I  have  shown  in  the  former  parts  of  this  work,  that  there  are 
certain  forms  of  irritation  in  the  stomach  which  succeed  to  affec- 
tions in  the  first  instance  inflammatory,  which  are  benefited  by  a 
tonic  treatment.  The  disease,  at  first  one  of  inflammation,  having 
been  subdued,  terminates  in  one  of  debility  ;  and  the  remedies  found 
useful  in  the  earlier  forms  of  the  affection,  become  decidedly  injurious 
in  the  latter.  "We  often  find  pain,  distension,  acid  eructations, 
nausea,  and  vomiting,  with  tenderness  in  the  epigastrium,  succeed 
to  irritations  which  have  been,  at  the  onset,  benefited  by  leeches  to 
the  epigastrium,  warm  aperients,  and  a  rigid  diet.  These  symptoms 
are  very  liable  to  come  on  as  the  sequel  to  inflammatory  affections 
of  the  stomach  which  have  been  treated  with  large  losses  of  blood 
from  the  epigastric  region.  Most  of  the  cases  detailed  by  M.  Barras, 
cured  by  tonics  and  a  full  diet,  were  diseases  of  debility  in  the  sto- 
mach produced  in  this  way.  The  great  art  in  managing  affections 
of  the  stomach  of  this  kind  is  to  mark  the  point  at  which  the  disease 
ceases  to  be  inflammatory  and  passes  into  one  of  debility  or  of  sen- 
sibility. It  is  at  such  a  time  that  the  antiphlogistic  plan  should  be 
abandoned,  and  tonics  and  a  fuller  diet  substituted  for  it.  I  have 
frequently  been  consulted  by  patients  who  have  been  reputed  the 
subjects  of  confirmed  chronic  gastritis  ;  they  have  been  pale,  ema- 
ciated, tormented  with  pain  and  sickness,  and  have  had  stomachs 
so  sensible  that  they  could  hardly  take  the  least  particle  of  food 
without  pain.  These  persons  have  been  treated  with  leeches  to 
the  stomach,  which  have  at  first  afforded  relief;  subsequently,  by 
different  modes  of  counter-irritation,  blisters,  and  the  tartar  emetic 
ointment :  still  they  go  on  getting  worse,  the  gastric  symptoms  con- 
tinue and  they  are  supposed  to  be  suffering  from  an  incurable 
chronic  gastritis.  These  cases  were  originally  inflammatory  affec- 
tions ;  the  inflammation  has  been  subdued,  and  passed  on  to  a  dis- 
ease of  debility.  This  has  been  accompanied  by  its  peculiar  symp- 
toms, which  have  been  supposed  to  depend  on  a  continuance  of 
the  inflammation  when  they  were  due  to  an  opposite  cause.  By 
placing  such  cases  on  a  full  diet,  and  exhibiting  freely  the  carbo- 
nate of  iron,  the  symptoms  have  soon  given  way,  and  the  patients 
have  speedily  recovered  their  usual  health,  all  the  unpleasant 
symptoms  connected  with  the  stomach  speedily  subsiding.  The 
combinations  of  the  carbonate  of  iron  with  the  muriate  of  morphia, 
in  such  cases,  if  much  pain  exist,  or  with  rhubarb,  if  constipation  be 
present,  are  perhaps  among  the  best  remedies  that  can  be  employed. 


ANALYTICAL  INDEX. 


CHAPTER  I. 

PAGE. 

On  morbid  states  of  the  stomach  characterised  by  increased  vascularity,     . 

Two  primitive  morbid  states  common  to  the  stomach ;  affections  of  its  sensibility 
and  vascular  irritations,  ..... 

The  first  primitive  morbid  state,  one  of  fulness  of  blood  in  its  mucous  coat, 

Symptoms  by  which  it  is  indicated,        ...... 

Case,  illustrating  its  pathology,         . 

This  condition  of  the  stomach  one  of  hyperemia  distinct  from  inflammation, 

No  distinct  line  to  be  drawn  between  hyperemia  of  the  stomach  and  inflammation  ; 
the  difference  in  degree,  not  in  kind,  .... 

Terminations  of  hyperemia  of  the  stomach  ;  if  continued  may  end  in  true  inflam- 
mation of  this  organ,  or  produce  disease  in  the  liver,  brain,  lungs  or  heart, 

Inflammatory  and  feverish  diseases  generally  accompanied  by  active  hyperemia  of 
the  stomach  ;  importance  of  ascertaining  the  state  of  the  stomach  before  framing 
the  plan  of  treatment  in  any  disease,  .  .  • 

State  of  the  stomach  at  the  commencement  of  the  eruptive  and  continued  fevers,        12 

CHAPTER  II. 

On  morbid  states  of  the  stomach  dependent  upon  anemia, 

Laborious  and  painful  digestion  occasionally  succeeds  to  large  losses  of  blood  from 

different  organs  of  the  economy,       .... 

Case,  illustrating  the  symptoms  and  mode  of  treatment  of  this  state  of  the  stomach,    13 
Case — nausea,  vomiting,  acidity,  &c ,  succeeding  to  large  losses  of  blood  from  the 

uterus;  cured  by  tonics,        .  ... 

Case,  resembling  inflammation,  depending  upon  the  same  cause  ;  cured  by  tonics,      14 
Case  of  the  same  kind;  cured  by  tonics,  . 

Physiological  observations  on  these  forms  of  disease,         .  ...  .15 

CHAPTER  III. 

General  review  of  the  symptoms  and  sympathies  dependent  on  vascular  irritation 
of  the  stomach,  ........ 

Inflammatory  nature  of  some  forms  of  indigestion, 

Symptoms  ;  state  of  the  tongue  in  the  primary  forms  of  vascular  irritation  of  the 
stomach,  .  .  .  .  .  .  .  . 

Of  the  state  of  the  epigastric  and  hypochondriac  regions,  .  •  .18 

Of  the  symptoms  of  vascular  irritation  of  the  stomach,  observed  in  the  organs  of 
respiration,  ........ 

In  the  organs  of  circulation ;  state  of  the  pulse  and  heart, 

Of  symptoms  presented  by  the  brain  and  senses,  . 

Of  the  variable  seats  of  pain  accompanying  these  states,  .  •  • 


188  ANALYTICAL  INDEX. 

• 

CHAPTER  IV. 

PAGE. 

Of  confirmed  inflammatory  affections  of  the  stomach,        .  .  .  .23 

Of  inflammatory  affections  of  the  stomach  accompanied  by  a  peculiar  condition  of 
the  tongue,    .........  23 

Case — aphthous  condition  of  the  tongue  coinciding  with  symptoms  of  chronic  in- 
flammation  of  the  stomach,         .  .  .  .  .  .  .24 

This  state  of  the  tongue  may  be  purely  local,  and  exist  without  any  affection  of 
the  stomach,        .........       25 

The  state  of  the  tongue,  in  stomach  diseases,  deceptive ;  does  not  afford  certain 
data  of  the  kind  or  degree  of  disease  existing  in  the  stomach  ;  first  series  of  facts 
— the  tongue  natural  and  the  stomach  diseased,        ....  26 

Case — pale  moist  tongue,  co-existing  with  inflammation  and  softening  of  the  sto- 
mach, .........  26 

Case — pale  moist  tongue,  inflammation  with  softening  of  the  stomach,      .  .       26 

Case — inflammation   and  softening  of  the  stomach,  moist,  contracted  and  pale 
tongue,    ..........      26 

Second  series  of  facts  in  which  the  tongue  is  morbid  and  the  stomach  healthy,  27 

Case  in  illustration,  .  .  .  .  .  .  .    "        .      27 

Third  series,  in  which  both  stomach  and  tongue  are  morbid,  .  .  27 

Case  in  illustration,  ........      27 

Case  in  illustration,      ........  27 

Great  vascularity,  and  development  of  the  papillae  of  the  tongue  commonly  indi- 
cative of  irritability  of  the  stomach,  .....  27 

Of  the  symptoms  of  inflammatory  affections  of  the  stomach  drawn  more  particu- 
larly from  the  organ  itself,     .......  28 

Of  the  appetite,  and  sensations  produced  in  the  stomach  by  eating,  .  .      28 

Of  the  seats,  and  characters  of  pain,      ......  29 

Pain  seated  in  the  left  hypochondrium  when  disease  is  confined  to  the  greater 
curvature  of  the  stomach,  .  .  .  .  .  .  .30 

Pain  and  tenderness  in  the  epigastrium  not  pathognomonic  of  a  diseased  condition 
of  the  stomach.     Reasons  why  this  is  so  frequent,    ....  30 

Fulness  and  distension  after  meals,  .  .  .  .  .  .31 

Chronic  vomiting,          ........  31 

As  a  symptom  of  inflamed  condition  of  the  mucous  coat  of  the  stomach,  more  com- 
mon at  the  commencement  of  disease,  and  when  the  chronic  assumes  the  more 
acute  form,    .........  32 

Case  in  illustration,  ........      32 

Case  in  illustration,       ........ 

Vomiting  may  depend  upon  many  other  causes  than  inflammation  of  the  stomach, 
frequently  upon  affections  of  other  organs,     .....  33 

Frequent  attacks  of  vomiting,  apparently  depending  on  a  mere  functional  affection 
of  the  stomach,  sometimes  lay  the  foundation  of  organic  disease;  case  in  illus- 
tration, ....  33 

Manner  in  which  the  inflammatory  forms  of  indigestion  produce  disease  in  other 
organs,  symptoms  by  which  the  extension  of  disease  to  other  parts  is  indicated, 
— nature  of  the  disease,  produced,     .  .  .  . 

Two  characters  of  pain  occurring  in  patients  suffering  from  chronic  inflammation 
of  the  stomach — neuralgic  and  inflammatory,  ....  34 

Case — illustrative  of  that  character  of  pain,  strictly  dependent  upon  inflammation, 
and  of  the  treatment  adopted  to  relieve  it,     .  .  .  .  .  35 

Case — illustrative  of  the  neuralgic  form  of  pain  which  accompanies  an  inflamed 
condition  of  the  stomach,  mode  of  treatment  suited  to  it,  different  from  that  of 
the  former,  .........  35 

CHAPTER  V. 

On  affections  of  the  stomach  characterised  by  derangement  of  its  sensibility,  36 

Morbid  states  of  the  sensibility  of  the  stomach, — lesions  of  innervation  may  exist 
*•  without  inflammatory  action,  ....*.  36 

Such  affections  occasionally  succeed  to  inflammation,       .  .  .  .37 


ANALYTICAL  INDEX. 


189 


PACK. 

Diseases  of  the  sensibility  sometimes  closely  resemble  forms  of  chronic  inflamma- 
tion ;  case  in  illustration,  .  .  .  .  .  .  .37 

Fatal  cases  uf  chronic  vomiting,  and  pain  in  the  stomach  without  appreciable  dis- 
ease,       ..........       37 

Varieties  of  form  which  diseases  of  the  sensibility  assume,       ...  38 

Succeed  to  haemorrhages,  and  to  large  local  depletions  from  the  region  of  the 
stomach,       .  .....  39 

Frequently  combined  with  inflammatory  action,     .  .  .  .  .40 

Treatment  suited  to  the  different  forms,  .....  40 

Case — Severe  pain  after  eating,  accompanied  by  a  discharge  of  glairy,  and  acid 
fluid  from  the  mouth,  gradual  emaciation  from  the  long  continuance  of  disease. 
Observations,  and  mode  of  treatment  applicable  to  such  affections,  .  41 

Case — Morbid  sensibility  of  the  stomach  ;  great  mental  uneasiness  ;  epigastric  pul- 
sation ;  nature  of  those  forms  of  disease;  mode  of  treatment  appropriate,  44 
Case — morbid  sensibility  of  the  stomach,           ....             .46 

Case — morbid  sensibility ;  great  mental  distress,    . 

Case — morbid  sensibility,  &c.,  ......  47 

Diseases  of  the  sensibility  of  the  stomach,  sometimes  accompanied  by  vascular 
excitement,     .........  47 

General  plan  of  treatment — medicinal  and  dietetic,  .  .  .  .47 

Table  of  the  distinctions  between  the  symptoms  of  nervous  and  inflammatory  dis- 
eases of  the  stomach,       .  .  .  .  .  .  .  .49 

Sometimes  closely  resemble  each  other,  .....  51 

Occasionally  blended  during  the  progress  of  disease,          .  .  .  .51 

CHAPTER  VI. 

On  affections  of  the  stomach  characterised  by  morbid  states  of  its  secretions,  52 

A  disordered  condition  of  the  secretions  of  the  stomach  constitutes  a  third  primitive 
morbid  state,        .........       52 

Pathology  wf  this  state,  .......  53 

Its  symptoms  to  be  sought  for  in  the  stomach  itself,  or  in  the  sympathetic  irrita- 
tions of  other  organs,      ........       53 

State  of  the  tongue  and  epigastric  region,         .....  53 

Secretory  irritation  of  the  stomach  may  be  combined  with  inflammation  or  various 
affections  of  the  sensibility  of  the  stomach,    .....  54 

Case — secretory  irritation  of  the  stomach  ;  sympathetic  affection  of  the  head  ;  cure 
by  emetics,    .........  55 

Case — chronic  secretory  irritation  of  the  stomach ;   sympathetic  affection  of  the 
chest;  cure  by  emetics,          .......  56 

Case — secretory  irritation  of  the  stomach;  sympathetic  affection  of  the  chest  simu- 
lating pleurisy,  ........  57 

Case — secretory  irritation  of  the  stomach;  sympathetic  affection  of  the  breathing 
resembling  asthma,  .......  58 

Case — secretory  irritation  of  the  stomach  ;  sympathetic  affection  of  the  chest  simu- 
lating organic  disease  of  the  lung,    ......  58 

Secretory  irritation,  with  active  hyperemia  of  the  stomach;  treatment  suited  to 
these  forms  of  combination,  .  .  .  .  .  59 

Case — secretory  irritation,  with  active  hyperemia  of  the  stomach  ;  treatment  suited 
to  these  forms  of  combination,  ......  59 

Case — secretory  irritation,  with  inflammation  of  the  stomach,        .  .  .61 

Of  gastorrhcaa,  ........  63 

Anatomical  characters  of  the  disease,         .  .  .  .  .  .63 

Symptoms,        .........  63 

Treatment,  ...  •  •  •  •  •  •  .64 

CHAPTER  VII. 

On  the  influence  of  the  stomach  upon  other  organs,           .             .             .  .66 
Upon  the  liver,              .                                                 ... 

Mode  in  which  the  process  of  digestion  acts  upon  the  liver,          .             •  .66 

Transmission  of  sympathies  by  the  mucous  membranes,          ...  67 


190  ANALYTICAL  INDEX. 


By  the  veins,          .........       67 

Physiological  influence  of  the  stomach  upon  the  lungs,             ...  68 

Through  the  medium  of  the  nerves,            .             .             .             .             .  .68 

Mechanical  influence  of  a  distended  stomach,                ....  69 

Irritation  of  the  diaphragm,            .             .             .             .             .             .  .69 

Sympathies  of  the  mucous  membranes  of  the  two  organs,        ...  69 

Physiological  influence  of  the  stomach  upon  the  heart,      .             .            .  .71 

Mechanical  influence,                .             .             ...             .             .             .  71 

Influence  of  the  process  of  digestion,          .             .             .           '.             .  .72 

Of  active  hyperemia,  or  inflammation  of  the  stomach,               ...  73 

Physiological  influence  (if  the  stomach  upon  the  brain,      .             .             .  .74 

Relations  of  the  brain  and  the  epigastric  nervous  centre,          ...  74 

Influence  of  the  process  of  digestion,          .            .            .            .             .  .75 

Of  active  hyperemia  of  the  stomach,     ......  75 

State  of  the  intellectual  powers  the  result  of  this  state  of  the  stomach,       .  .       76 

Pathological  state  of  the  brain,              ......  77 

Brain  influenced  through  the  medium  of  the  heart,             .             .             .  .77 

State  of  the  brain  dependent  on  that  of  the  sensibility  of  the  stomach,              .  77 

CHAPTER  VIII. 

On  the  influence  of  morbid  states  of  the  stomach  upon  the  origin,  progress  and 

termination  of  diseases  of  the  liver,       ......  78 

On  the  primary  symptoms  of  diseases  of  the  liver,      ....  78 

Arise  insidiously  after  long  continued  gastric  irritability,  .  .  .78 

Causes,  according  to  Ferrus  and  Berard,        .....  79 

Influence  of  hyperemia  of  the  stomach  upon  the  origin  of  diseases  of  the  liver,  79 
Symptoms  of  the  earlier  forms  of  hepatic  diseases,           .             .             .             .79 

Constant  coincidence  of  gastric  disturbance  with  the  progress  of  diseases  of  the 

liver,      .  .  .......  80 

Nature  of  the  accompanying  affection  of  the  stomach,  ...  81 

Primitive  forms  of  hepatic  diseases,          ......  81 

Inflammatory  affections  of  the  stomach  coinciding  with  diseases  of  the  liver,  82 
Transmission  of  disease  from  the  stomach  to  the  liver  by  means  of  venous  inflam- 
mation,        .             .             .             .                         .             .             .             .  83 

On  some  of  the  symptoms  attendant  on  advanced  stages  of  diseases  of  the  liver,  83 

On  the  state  of  the  digestive  organs  in  the  latter  stages  of  diseases  of  the  liver,  84 
On  the  symptoms  observed  in  disturbances  of  the  circulation,       .             .            .84 

On  the  symptoms  observed  in  disturbances  of  the  organs  of  respiration,         .  8u' 
Particular  cases:  Case  1 — inflammatory  indigestion  for  twenty-five  years;  sub- 
acute  inflammation  of  the  stomach  ;  hypertrophy,  with  sanguinous  congestion  of 

the  liver,  .  .  .  .  .  .  .  89 

Remarks,  pathological  and  practical,  on  such  forms  of  disease,  .  .  90 

Case  2 — sub-acute  inflammation  of  the  stomach  and  bowels;  sudden  appearance  of 

diseases  in  the  liver,  .......  92 

Remarks,  .........  92 

Case  3 — symptoms  of  chronic  gastritis  of  long  standing;  schirrous  hardness  and 
great  enlargement  of  the  liver;  great  relief  afforded  by  exclusive  attention  to  the 

hepatic  disease,        ........  93 

Pathological  and  practical  remarks,          .  ....  93 

Case  4 — gastro-enteritis  ;  softening  and  disorganisation  of  the  liver  in  its  left  lobe,  95 

Remarks,  ..........  96 

Case  5 — dyspeptic  symptoms  for  two  years ;  gastritis ;  hepatitis ;  abscess  of  the 

liver ;  dropsy,  ........  97 

Remarks,         ......  .^  .  .  98 

Case  6— dyspeptic  symptoms  for  four  years ;  redness,  with  *softening  of  the  sto- 
mach; abscess  of  the  liver,  ......  98 

Pathological  and  practical  remarks,  ......  99 

Case  7 — chronic  inflammation  of  the  stomach  and  duodenum  ;  cancer  of  the  liver,  99 
Remarks,               .........       100 

Symptoms  observed  in  the  stomach,  which  precede  the  development  of  cancerous 
diseases  of  the  liver,     ........      101 


ANALYTICAL   INDEX.  191 


State  of  the  stomach  accompanying  hjdatids  of  the  liver,       .  .  .  101 

On  the  influence  of  the  stomach  upon  the  formation  of  biliary  calculi  and  upon  the 
bile,  .  .102 

The  natural  characters  of  the  bile  always  changed  in  protracted  affections  of  the 
stomach,  .....  ...  102 

Case  1 — dyspeptic  symptoms  during  life;  intestinal  inflammation;  alteration  of  the 
characters  of  the  bile,  .  .  .  .  .  .  .  102 

Remarks  on  these  forms  of  disease,  .  ...       102 

Case  2 — inflammatory  indigestion  for  twelve  months;  discharge  of  biliary  concre- 
tions per  anum,  .......  103 

Case  3 — inflammatory  indigestion  for  twenty-five  years;  confirmed  chronic  gastri- 
tis; death  from  acute  gastritis;  hypertrophy  of  the  liver;  disease  of  the  coats  of 
the  gall  bladder;  gall  stones;  alteration  of  the  characters  of  the  bile,  .  103 

Case  4 — inflammatory  indigestion  commencing  at  the  age  of  twenty,  subsequently 
confirmed  chronic  gastritis;  alterations  in  the  character  of  the  bile;  concretions; 
diseased  condition  of  the  mucous  membrane  of  the  gall  bladder,  .  .  104 

Case  5 — symptoms  of  indigestion;  chronic  gastritis;  hypertrophy  of  the  liver; 
biliary  concretion  ;  alterations  of  the  bile,  .....  104 

Case  6 — sub-acute  gastritis,  schirrous  gall-bladder,  biliary  concretions,  .  104 

Case  7 — dyspeptic  symptoms;  chronic  gastritis,  disease  of  the  gall-bladder;  biliary 
concretion,  .  .  ....  105 

Pathological  and  practical  remarks  on  the  preceding  cures,  .  .  105 

CHAPTER  IX. 

On  the  influence  of  morbid  conditions  of  the  stomach  upon  certain  forms  of 

dropsy,          .........  107 

Influence  of  hyperemia  of  the  stomach  upon  ascites,        ....  107 

State  of  the  stomach  modifies  the  treatment  in  this  disease,  .  .  108 

Nature  of  the  disease  in  the  stomach,  in  its  complication  with  dropsy,  .  109 

Case  in  illustration,     .....  .  .  109 

Slate  of  the  stomach  in  dropsy  accompanying  disease  of  the  heart,          .  .  109 

Case  in  illustration,      .  .  .  .  .  .  .  109 

On  the  use  and  abuse  of  digitalis  in  dropsy,          .....  110 

CHAPTER  X. 

On  the  influence  of  the  morbid  states  of  the  stomach  upon  the  origin,  progress,  and 
termination  of  diseases  of  the  heart,       ......       Ill 

Case  1 — palpitations  after   meals  for  some  months;  the  meals  also  succeeded  by 
flatulence  and  nausea;  subsequently  acute  gastritis,  with  inordinate  action  of  the 
heart,     .  .  .  ...  .  .  .  .  .111 

Pathological  and  practical  remarks  on  these  forms  of  disease,  .  .  112 

Case  2 — irregular  action  of  the  heart;  intermittent  pulse,  caused  by  inflammation 

of  the  stomach;  no  disease  of  the  heart  to  account  for  its  irregular  action,      .       113 
Remarks  on  such  forms  of  disease,      ......  113 

Similar  case  quoted  from  Cruveilhier,       ......       113 

Causes  of  irregularities  in  the  heart's  action,  .  .  .  114 

Peculiarities  of  pulse  dependent  upon  hyperemia,  or  inflammation  of  the  stomach,    115 
Cases  in  illustration,  .......  115 

Remarks  on  the  varieties  in  the  condition  of  the  pulse  accompanying  different 
forms  of  disease  in  the  stomach,       .  .  .  .  .  116 

Of  the  association  of  disease  of  the  stomach  with  disease  of  the  heart,      .  .       118 

Case  8— disease  of  the  heart;  fungoid  ulceration  of  the  mitral  valve,  with  inflamma- 
tion of  the  mucous  coat  of  the  stomach  ;  great  relief  afforded  to  the  symptoms  of 
disease  of  the  heart  by  mitigating  that  of  the  stomach,  .  .  .       118 

Practical  remarks  on  the  co-existence  of  these  diseases,          .  .  .  119 

Symptoms  accompanying  them,  ......       119 

Treatment — effects  of  remedies,  ......       122 

State  of  the  stomach  in  acute  affections  of  the  heart,  .  .  .  122 

Influence  of  the  stomach  upon  organic  affections  of  the  heart,    .  .  .       122 

Case  in  illustration,     .  .  .  ...  .  .  .  122 


192  ANALYTICAL  INDEX. 

.^ 

PAGE 

Influence  of  protracted  gastric  diseases  upon  the  physical  condition  of  the  heart,  123 

Case  in  illustration,  .  .  ...  123 

General  history  of  the  influence  of  the  stomach  upon  the  heart,          .  .  124 

Irregularities  in  its  pulsation  dependent  on  gastric  irritation,       .  .  .  124 

State  of  stomach  producing  them,       ......  124 

Sympathetic  irritations  of  the  heart  stimulating  organic  disease,  .  .  125 

The  irregularities  in  the  action  of  the  diseased  heart  are  rendered  more  severe  by 

complaint  existing  in  the  stomach,  .....  126 

Pathology  of  the  stomach  during  organic  diseases  of  the  heart,  .  .  127 

Use  and  abuse  of  digitalis,      .......  128 

CHAPTER  XL 

On  the  influence  of  morbid  states  of  the  stomach,  upon  the  origin,  progress,  and 

termination  of  diseases  of  the  lungs,  .....       128 

Case  1 — incessant  cough,  depending  on  inflammation  of  the  stomach ;  cured  with 

the  later  affection,  .  .  .  ...  .  128 

Remarks  upon  cough  depending  on  affections  of  the  stomach,     .  .  .       129 

Case  2 — cough  dependent  upon  chronic  inflammation  of  the  stomach;  cure  with 

the  stomach  disease,         .  .  .  .  .  .  .  130 

Remarks,  .........       130 

Case  3 — long  continued  chronic  inflammation  of  the  stomach  with  cough;  profuse 

muco-purulent  expectoration,       ......  131 

Remarks,  .  ......       132 

Case  4 — sub-acute  inflammation  of  the  stomach,  producing  the  symptoms  of  an 
inflammatory  affection  of  the  lungs ;  cure  of  the  pectoral  by  the  removal  of 
the  stomach  disease,         .  .  .  .  .  .  .  132 

Case  5 — inflammation  of  the  stomach,  stimulating  inflammation  of  the  mucous 
membrane  of  the  lungs;  healthy  condition  of  the  lungs  ascertained  after  death; 
disease  confined  to  the  mucous  membrane  of  the  stomach,  .  .       133 

Remarks,         .........  134 

Case  6 — inflammatory  affection  of  the  stomach,  simulating  an  inflammatory  dis- 
ease of  the  lungs ;  healthy  condition  of  the  lungs  ;  disease  confined  to  the 
mucous  membrane  of  the  stomach,    ......       134 

Remarks,        .........  135 

Case  7 — inflammatory  affection  of  the  stomach,  accompanied  by  symptoms  resem- 
bling a  similar  condition  of  the  lungs;  healthy  state  of  the  lungs;  source  of 
disease  in  the  stomach,          .......       135 

Remarks  un  the  symptoms  exhibited  in  the  three  last  cases,  .  .  136 

Case  8 — inflammatory  affection  of  the  stomach  accompanied  by  cough,  and,  subse- 
quently, symptoms  resembling  pleurisy;  origin  of  disease  in  the  stomach  alone.  137 
Case  9 — long  continued  gastric  irritation,  accompanied  by  pain  in  the  chest  resem- 
bling pleurisy,  and  irregular  action  of  the  heart.       ....       137 

Remarks,         .  .  .  .  .  .  .  .  138 

Case  10 — inflammation  of  the  lungs  complicated  with,  and  apparently  succeeding 
to,  that  of  the  stomach  ;  cure  of  the  pulmonary  by  the  chief  attention  to  the 
stomach  disease,        ........       138 

Case  11 — inflammation  of  the  lungs  complicated  with  that  of  the  stomach;  influ- 
ence of  the  latter  over  some  of  the  symptoms  exhibited  by  the  former,  140 
Case  12 — pleuro-pneumonia  co-existing  with  intestinal  inflammation,             .  141 
Remarks  upon  the  exhibition  of  certain  remedies  in  such  states  of  disease  as  the 

preceding,      .........       141 

Case  13 — consumption  of  the  lungs,  succeeding  to  long-continued  gastric  irritation 

of  the  inflammatory  kind,  ......  142 

Remarks  on  the  nature  of  such  diseases,  .....       142 

Case  14 — inflammatory  irritation  of -.the  stomach  producing  consumption,      .  144 

Case  15 — consumption  succeeding  to  chronic  inflammation  of  the  stomach,         .       146 
General  history  of  diseases  of  the  stomach,  in  their  influence  upon  the  origin,  pro- 
gress, and  termination  of  diseases  of  the  lungs, 

Nature  of  the  symptoms  which  indicate  pulmonary  irritation  arising  in  the  stomach,  147 
Cough  after  food,  .  .       147 

Indolence  of  the  epigastrium  in  such  states,  .  .  .  .  17 


ANALYTICAL  INDEX.  193 

PAGE 

Mode  of  distinguishing  the  pulmonary  irritations  which  depend  on  morbid  states 

of  the  stomach,          ...  ....       147 

Hurried  and  irregular  respiration  from  gastric  irritation,       .  .  .  149 

Mode  in  which  irritation  extends  from  the  stomach  to  the  lungs,  .'  .       149 

Nervous  irritation  of  the  lung,  the  result  of  gastric  disturbance,  terminates  in  con- 
gestion or  inflammation,  ......  150 

Various  forms  of  irritation  in  the  lungs,  existing  without  the  physical  signs  of  dis- 
ease ;  mode  of  distinguishing  their  origin  when  physical  signs  of  disease  in 
the  lung  are  present,  .  .  .  .  .  .  .       151 

Simultaneous  occurrence  of  diseases  of  the  stomach  and  lungs,  .  .  151 

Profuse  discharges  of  muco-purulent  matter  from  the  lungs  occasionally  cure  dis- 
eases of  the  stomach,  .  .  .  .  .  .       152 

False  pleurisy  from  stomach  derangement,     .....  152 

Inflammation  of  the   lungs   succeeding  to,  and   complicated   with,  that  of  the 

stomach ;  bilious  pneumonia  of  Stoll,  .....       152 

Tubercular  consumption  from  protracted  gastric  and  gastro-enteric  irritation,  154 

Hemoptysis  from  the  same  cause,       .  ...  155 

CHAPTER  XII. 

On  the  influence  of  morbid  states  of  the  stomach  upon  the  origin,  progress,  and 

termination  of  diseases  of  the  brain,  .....       156 

The  functions  of  the  brain  deranged  under  the  influence  of  diseased  conditions  of 

the  stomach,         ........  156 

Character  of  these  derangements,  ......       156 

Changes  in  the  stomach  and  brain,  upon  which  these  functional  affections  appear 

to  depend,  .  .  .  .  .  '  .  .  156 

Sympathetic  affections  of  the  brain  which  accompany  the  process  of  digestion,         157 
Cases  1  and  2 — state  of  the  brain  produced  by  active  hyperemia  or  inflammatory 

affections  of  the  stomach,       .......       157 

Case  3 — influence  of  diseased  conditions  of  the  stomach,  the  result  of  moral  im- 
pressions, upon  the  brain,  ......  159 

Remarks  on  these  forms  of  disease,          ......      159 

The  brain  influenced  by  the  stomach  in  two  ways — by  the  direct  transmission  of 
sympathetic  irritation  frcm  one  organ  to  the  other,  and  through  the  medium 
of  the  heart,  ........       161 

Case  4 — influence  of  the  stomach  upon  the  brain,  through  the  medium  of  the  heart,  161 
Remarks  on  these  complications,         ......  161 

Case  5 — influence  of  morbid  states  of  the  stomach  upon  prganic  diseases  of  the  brain,  163 
Remarks  on  gastric  apoplexy,       .  .  .  .  .  .  .163 

Case  6 — stupor  and  convulsions  dependent  on  active  hyperemia  of  the  stomach,         165 
Remarks,         .........  165 

Case  7 — giddiness,  stupor,  and  affections  of  the  senses,  dependent  upon  an  inflam- 
matory affection  of  the  stomach,  combined  with  a  morbid  condition  of  its  sen- 
sibility,         .  ......      165 

Remarks  on  these  forms  of  disease,  and  the  use  of  aperient  medicines  in  affections 

of  the  stomach  generally,  ,  .  .  .  .  .  166 

Case  8 — fatal  affection  of  the  brain  suddenly  supervening  upon  gastric  irritation,      167 
Fatal  tetanic  convulsions  excited  by  inflammation  of  the  stomach,  .  .       168 

Influence  of  the  stomach  upon  the  mind,        .....  168 

Cases  of  lunacy  and  mania  in  illustration,  .  .  .  .  .169 

Mental  despondency  dependent  upon  Anemia  of  the  stomach  ;  cure  by  tonics,  170 

Influence  of  digestion  upon  the  brain,  .  .  .  .  .  170 

Of  active  hyperemia  of  the  stomach  upon  the  brain,         .  .  .  .       171 

Nature  of  the  affections  of  the  stomach  which  act  upon  the  brain,     .  .  171 

Character  of  the  affections  thus  produced  in  the  brain,     ....       171 

CHAPTER  XIII. 

Of  the  treatment,       .....  173 

Of  the  treatment  of  those  forms  of  disease  of  the  stomach  whose  prominent  symp- 
toms are  pain  and  constipation,         ......       173 

12— e  park  13 


194  ANALYTICAL  INDEX. 

PAGE 

Of  the  treatment  where  vomiting  and  diarrhoea  are  the  predominant  symptoms,        175 
Of  the  treatment  of  the  more  acute  forms,  characterised  by  great  epigastric  tender- 
ness and  irritability  of  the  vascular  system,         ....  176 

Treatment  where  fulness,  distension,  and  acidity,  with  flatulence  and  eructations 

after  meals,  are  the  predominant  symptoms, 
Of  the  employment  of  general  and  local  bleeding  in  the  treatment  of  diseases  of 

the  stomach,         ........  180 

Of  the  use  of  aperient  medicines,  ......       181 

Of  sedatives,  .......  181 

Of  antacid  a.nd  absorbent  remedies,  ......       183 

Of  tonics,        «.*«.,....  183 


